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。     

儿童青少年肥胖干预方法研究新进展

肥胖已经成为威胁人类健康的常见公共问题,采取有效的防控措施势在必行。本文从儿童肥胖干预角度出发,综述营养干预、身体活动干预、行为干预、数字技术、药物治疗、手术治疗等干预策略及相关机制。     

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.     

Costing a pilot complex community‐based childhood obesity intervention

Background: Childhood obesity has significant impact on future health and economic consequences. Evidence of effectiveness of interventions is developing, although little is known about costs. Therefore, the direct costs to health care and other public sector agencies of a pilot community‐based childhood obesity treatment programme were estimated. Methods: The present study comprised a retrospective review of resource use of an intervention drawing resources from local government and primary care sectors and delivered across multiple settings. Ninety‐six children, aged 8–16 years old; body mass index (BMI) >98th centile; mean BMI SD 3.1 and low quality of life scores attended a 12‐month programme delivered by nonhealth professionals. Direct costs to health care and other public sector agencies were assessed. Results: Total programme direct costs were £82 380 (€94 736, $123 569) in the base case or £120 474 (€138 546, $180 713) when venues were treated as real additional costs, and varied only slightly with the number of participants in the programme. Costs per participant were £858 (€987, $1287) in the base case or £1255 (€1443, $1883) when venues were treated as additional costs. Costs per participant were sensitive to the number of participants, varying between £691 (€795, $1037) and £2026 (€2330, $3039) when venue costs were zero and between £1009 (€1160, $1514) and £2978 (€3425, $4467) with venue costs added. Conclusions: It is possible to provide a community‐based service at reasonable cost, and probably less than for health professional delivered services. Further work is required to assess the possible effects of the programme on wider service resource use, on users’ costs and on programme effectiveness.     

闵行区中小学学生单纯性肥胖干预效果评价

目的　研究探索适合于上海市闵行区儿童青少年单纯性肥胖的干预方案 ,为全社会开辟儿童表少年肥胖干预新途径提供参考依据。方法　组建学校卫生、心理、营养、临床多学科交叉研究小组 ,从知识、行为、饮食及环境整治等多个环节 ,对干预学校进行多管齐下的群体综合干预 ,并对干预前后研究对象的肥胖超重度变化进行比较。结果　干预组超重学生经过 1年干预后 ,有 4 0 4 0 %学生体重转为正常 ,对照组为 2 1 84 5 (P <0 0 1) ;干预组 11 2 5 %学生体重转为肥胖 ,而对照组达到 2 7 19% (P <0 0 1)。在干预组中男女生体重下降程度差异无统计学意义。小学生与中学生比较干预效果差异无统计学意义。结论　以不校为基础的肥胖干预计划对控制闵行区儿童青少年肥胖有较显著的效果。长期坚持则需要学校领导、督导老师、家长及学生本人的配合 ,小学生的肥胖干预更需要家长的支持与关心。     

School-based obesity interventions: a literature review

BACKGROUND: Childhood obesity is an impending epidemic. This article is an overview of different interventions conducted in school settings so as to guide efforts for an effective management of obesity in children, thus minimizing the risk of adult obesity and related cardiovascular risk. METHODS: PubMed and OVID Medline databases were searched for school-based obesity interventions with anthropometric measures in children and adolescents between the ages of 7 and 19 years from June 1986 to June 2006. Studies were reviewed by duration, type of intervention, and defined qualitative and quantitative measures, resulting in a yield of 51 intervention studies. RESULTS: The interventions ranged from 4 weeks in length to as long as 8 continuing years. In total, 15 of the intervention studies exclusively utilized physical activity programs, 16 studies exclusively utilized educational models and behavior modification strategies, and 20 studies utilized both. In addition, 31 studies utilized exclusively quantitative variables like body mass indices and waist-to-hip ratios to measure the efficacy of the intervention programs, and another 20 studies utilized a combination of quantitative and qualitative measures that included self-reported physical activity and attitude toward physical activity and the tested knowledge of nutrition, cardiovascular health, and physical fitness. A total of 40 studies achieved positive statistically significant results between the baseline and the follow-up quantitative measurements. CONCLUSIONS: No persistence of positive results in reducing obesity in school-age children has been observed. Studies employing long-term follow-up of quantitative and qualitative measurements of short-term interventions in particular are warranted.     

Childhood obesity: successes and failures of preventive interventions

Despite progress toward assuring the health of today's young population, the 21^st century began with an epidemic of childhood obesity. There is general agreement that the situation must be addressed by means of primary prevention, but relatively little is known about how to intervene effectively. The evidence behind the assumption that childhood obesity can be prevented was discussed critically in this roundtable symposium. Overall, there was general agreement that action is needed and that the worldwide epidemic itself is sufficient evidence for action. As the poet, writer, and scholar Wittner Bynner (1881–1968) wrote, "The biggest problem in the world could have been solved when it was small".     

Prevalence of overweight and obesity among preadolescent schoolchildren in Galicia,Spain

Background Childhood obesity is rising rapidly in many countries. Preadolescents appear to be at particularly high risk. This study estimated the prevalence of overweight and obesity in preadolescent schoolchildren in Galicia, Spain. Methods The heights and weights of a random sample of 2305 Galician schoolchildren aged 10–12 years were measured using calibrated standardized scales and measures. Overweight and obesity were identified using the criteria of the International Obesity Task Force. Results The prevalences of obesity and overweight were respectively 9.2% and 31.0% among boys, 8.6% and 28.8% among girls and 8.9% and 29.9% overall. Taking boys and girls together, the combined prevalence of overweight and obesity fell significantly with increasing age. Overweight was more prevalent in rural than urban areas (30.7% vs. 28.4%), as also was obesity (9.8% vs. 7.2%). Conclusions Our study evidences the emergence of the obesity epidemic among preadolescents in Galicia, especially in rural areas. Both overweight and obesity in this age group are more prevalent in Galicia than in other areas of Spain or most other Western nations.     

Estimates of overweight and obesity among samples of preschool-aged children in Melbourne and Sydney

Objective: Childhood obesity is a significant and increasing public health issue. We present results from two cross‐sectional surveys from Melbourne and Sydney that sought to estimate the level of overweight and obesity among preschool‐aged children. Methods: In Melbourne, weight and height of 196 children from 12 randomly selected preschools and kindergartens were measured and recorded. In Sydney, data on weight and height of 325 children attending four early childhood centres were extracted from client records. The two studies used the age and gender‐specific body mass index criteria for classifying overweight and obesity. Results: The prevalence of Melbourne preschool‐aged children considered overweight was 15.3% for boys and 17.3% for girls, with a further 7.1% of boys and 8.2% of girls considered obese. In Sydney, the proportion of children considered overweight was 15.3% for boys and 26.3% for girls. An additional 8.7% of boys and 8% of girls were considered obese. Conclusion: There is some evidence that childhood obesity may begin in the preschool years. Intervention programs targeting obesity should be considered for families with preschool‐aged children in urban Australia.     

上海市某幼儿园单纯性肥胖综合干预的动态研究

[目的]通过对学龄前儿童肥胖综合干预,探索减少肥胖流行的有效途径。[方法]选择上海市某区2所幼儿园,并随机将儿童分为干预组(177名)和对照组(162名),于2004年9月~2005年6月对干预组超重和肥胖儿童实施干预。干预方法:采取家园联合管理模式,实施饮食管理、体育锻炼和健康教育相结合的综合干预措施。定期监测2组儿童体格发育各项指标并进行比较,统计方法采用t检验。[结果]干预组中正常体重男女儿童平均体重分别增加1.5和2.4kg,对照组增加1.7kg和2.9kg;超重和肥胖亚组男女童平均体重分别增加了及1.5kg和1.7kg,对照组增加1.8和1.9kg。干预组及对照组所有儿童在干预结束时平均身高均比干预前增长5 cm左右。干预组中儿童体质指数(BM I)的Z分值在干预结束时均有所下降。对照组BM I的z分值男童有所增加,女童略有下降。干预结束时,干预组超重检出率不变,为14.3%。肥胖检出率从5.1%轻微上升为6.3%,而对照组超重从19.5%降为16.9%,肥胖从9.8%上升至14.9%。[结论]采用家园联动管理模式,以健康教育、饮食调整、加强体锻为手段的综合干预措施有效地遏制了该所幼儿园儿童肥胖流行进一步发展。     

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.     

Estimates of the energy deficit required to reverse the trend in childhood obesity in Australian schoolchildren

Objectives: To estimate: 1) daily energy deficit required to reduce the weight of overweight children to within normal range; 2) time required to reach normal weight for a proposed achievable (small) target energy deficit of 0.42 MJ/day; 3) impact that such an effect may have on prevalence of childhood overweight. Methods: Body mass index and fitness were measured in 31,424 Australian school children aged between 4.5 and 15 years. The daily energy deficit required to reduce weight to within normal range for the 7,747 (24.7%) overweight children was estimated. Further, for a proposed achievable target energy deficit of 0.42 MJ/day, the time required to reach normal weight was estimated. Results: About 18% of children were overweight and 6.6% obese; 69% were either sedentary or light active. If an energy deficit of 0.42 MJ/day could be achieved, 60% of overweight children would reach normal weight and the current prevalence of overweight of 24.7% (24.2%–25.1%) would be reduced to 9.2% (8.9%–9.6%) within about 15 months. Conclusions: The prevalence of overweight in Australian school children could be reduced significantly within one year if even a small daily energy deficit could be achieved by children currently classified as overweight or obese.     

儿童青少年肥胖门诊干预效果分析

目的 对肥胖门诊儿童青少年肥胖干预效果进行评价,以了解干预效果及影响因素。方法 1995-2011年肥胖门诊就诊肥胖患儿1 045人,选取随访时间持续1个月以上的115人,评价肥胖干预效果及其影响因素。结果 初诊肥胖患儿1 045人(男712人,女333人),随访时间持续1个月以上115人(男74人,女41人),低年龄组(≤11岁)及高年龄组(>11岁)经门诊干预1~3个月、4~6个月及6个月以上干预后,肥胖度分别降低8.8%和7.8%、18.8%和16.5%、27.4%和25.2%。两个年龄组在肥胖门诊干预4~6个月和6个月以上显效率(87.2%和87.5%)明显高于1~3个月(51.6%)((χ²=26.29,P<0.01))。初诊肥胖度及随访持续时间与肥胖度改善正相关(r分别为0.35和0.53,P＜0.01),初诊年龄与肥胖度变化负相关(r=-0.24,P＜0.05)。 结论 通过肥胖门诊对肥胖患儿进行相关健康指导有助于儿童肥胖的预防和控制,但目前肥胖门诊患儿的依从性还不是很乐观。     

城区婴幼儿肥胖综合干预研究

【目的】 探讨城区婴幼儿肥胖干预措施,为临床有效指导提供依据。 【方法】 制定适合社区儿保医生实施的婴幼儿肥胖干预方案,针对看护人开展婴幼儿饮食健康促进活动,干预周期为一年。 【结果】 干预组婴儿食物转换月龄晚于对照组,进食肉类、蔬菜及水果的频率多于对照组,进食甜饮料的频率少于对照组;随访一年后婴儿超重和肥胖的比例显著低于对照组,两组儿童营养状况构成差异有统计学意义(P＜0.05),但身长的线性生长无差异。 【结论】 城区婴幼儿肥胖干预方案适用于社区医疗保健机构,简单易行且安全有效。     

A simple, and potentially low-cost method for measuring the prevalence of childhood obesity

BACKGROUND: Recent official publications have highlighted obesity as one of the biggest threats to public health and the prevalence of obesity in children is widely believed to be rising rapidly. However, there are no data on the prevalence of childhood obesity at a local level. We have developed a simple low-cost method of gaining such data by working with local schools. METHOD: We designed our method on the observation that numeracy and data handling skills are often taught in schools by getting children to measure their height and weight. We recruited seven schools and offered them a numeracy lesson plan suitable for year 5 (aged 9-10) children together with healthcare staff to attend the lesson. As part of the lesson, each child's height and weight was measured and recorded anonymously. Parental consent was obtained on an 'opt out' basis. The method was evaluated by questionnaire. RESULTS: We gained data on body mass index for 252 children. In total, 20% of the children were overweight, and 7% obese. The brief questionnaire survey indicated that both teachers and school nurses were happy with the method and would repeat it. Weighing was carried out sensitively. CONCLUSION: Our findings were in line with national studies of the prevalence of childhood obesity. The method was simple, low-cost and acceptable to schools and school nurses. There seems no reason why this project cannot be used more widely across the Primary Care Trust (PCT) and beyond. We now propose to roll out the method across all primary schools in Birmingham.     

Effects of Three Different Family-Based Interventions in Overweight and Obese Children: The “4 Your Family” Randomized Controlled Trial

Childhood overweight and obesity prevalence has risen dramatically in the past decades, and family-based interventions may be an effective method to improve children’s eating behaviors. This study aimed to evaluate the effectiveness of three different family-based interventions: group-based, individual-based, or by website approach. Parents and school aged overweight or obese children, 8–12 years of age, were eligible for the study. A total of 115 children were randomly allocated in one of the three interventions, and 91 completed the study (79% compliance); Group 1 (n = 36) received group-based interventions by various experts; Group 2 (n = 30) had interpersonal family meetings with a dietitian; and Group 3 (n = 25) received training through a specifically developed website. Anthropometric, dietary, physical activity, and screen time outcomes were measured at baseline and at the end of the study. Within-group comparisons indicated significant improvement in body weight, body mass index (BMI)-z-score, physical activity, and screen time from baseline in all three study groups (p < 0.05). Furthermore, total body fat percentage (%TBF) was also decreased in Groups 2 and 3. Between-group differences varied with body weight and %TBF change, being larger in Group 3 compared to Groups 1 and 2, in contrast to BMI-z-score, screen time, and health behaviors, which were significantly larger in Group 2 than the other two groups. In conclusion, personalized family-based interventions are recommended to successfully improve children’s lifestyle and body weight status.     

安阳成年人肥胖社区干预研究的效果评价

为探讨成年人肥胖社区干预后效果 ,在安钢社区进行控制体重的健康教育活动 ,并在干预前后分别随机抽取干预社区 2 4 0 0人和对照社区 1 2 0 0人调查肥胖意识 ,体重、血脂、血糖等 ,对干预效果进行评价。结果显示 ,肥胖意识包括肥胖的危害 ,与慢病的关系、发生的相关因素、如何控制、判定标准和体质指数计算方法的知晓率等明显提高 (P <0 0 5) ;体重、血糖、血脂有下降趋势。提示运用健康促进的理论进行成年人肥胖社区干预效果明显 ,是控制体重促进健康的有效途径     

Multi‐profile hidden Markov model for mood,dietary intake,and physical activity in an intervention study of childhood obesity

Motivated by an application to childhood obesity data in a clinical trial, this paper describes a multi‐profile hidden Markov model (HMM) that uses several temporal chains of measures respectively related to psychosocial attributes, dietary intake, and energy expenditure behaviors of adolescents in a school setting. Using these psychological and behavioral profiles, the model delineates health states from the longitudinal data set. Furthermore, a two‐level regression model that takes into account the clustering effects of students within school is used to assess the effects of school‐based and community‐based interventions and other risk factors on the transition between health states over time. The results from our study suggest that female students tend to decrease their physical activities despite a high level of anxiety about weight. The finding is consistent across intervention and control arms. Copyright © 2013 John Wiley & Sons, Ltd.