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      Promoting healthful diet and physical activity in the Mexican school system for the prevention of obesity in children Translated title: Promoción de actividad física adecuada y alimentación saludable en el sistema educativo mexicano para la prevención de la obesidad infantil

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          Abstract

          Objective. This paper describes the rationale, design, and methods of a two-year randomized controlled trial conducted to evaluate the effectiveness of an environmental intervention in 27 elementary schools in Mexico City. Materials and methods. There were two units of analysis, school level addressing changes in elementary public part-time schools, and individual-level addressing behavioral changes in students 9 to 11 years of age. Two intensities of an intervention program were implemented (basic and plus), each containing two intervention components: physical activity and nutrition, supported by a communication/education component. Evaluation of the intervention was carried out during the school cycles 2006-2007 and 2007-2008. Results. Primary outcomes were overweight and obesity prevalence and fitness; environmental and behavioural measures were also examined. Conclusions. This is the first institutional multilevel, multifactorial project, consistent with the best practices available in current literature, carried out in Mexico to prevent childhood obesity in schools.

          Translated abstract

          Objetivo. El presente trabajo describe el protocolo, objetivo, el diseño y los métodos de un ensayo controlado aleatorio de dos años realizados para evaluar la efectividad de una intervención ambiental en 27 escuelas primarias de la Ciudad de México. Material y métodos. El protocolo consta de dos unidades de análisis: el nivel escolar donde se evaluaron los cambios en el entorno escolar de escuelas primarias publicas de medio tiempo y el nivel individual que evaluó los cambios de comportamiento en alumnos de 9 a 11 años de edad. Se implementaros dos tipos de intervenciones: nutrición y actividad física apoyadas de una estrategia de educación/comunicación. Las intervenciones tuvieron dos intensidades: básica y plus. La evaluación de la efectividad se llevó a cabo durante los ciclos escolares 2006-2007 y 2007-2008. Resultados. Los resultados iniciales reportan los métodos de evaluación de conducta individual así como la prevalencia de sobrepeso y obesidad. La evaluación ambiental reporta el protocolo de evaluación del entorno escolar. Conclusiones. Este es el primer proyecto de la de intervención escolar con un diseño multinivel, multifactorial, basado en literatura científica disponible y en investigación formativa para prevenir la obesidad infantil en las escuelas de la Ciudad de México.

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          Physical activity and food environments: solutions to the obesity epidemic.

          Environmental, policy, and societal changes are important contributors to the rapid rise in obesity over the past few decades, and there has been substantial progress toward identifying environmental and policy factors related to eating and physical activity that can point toward solutions. This article is a status report on research on physical activity and food environments, and it suggests how these findings can be used to improve diet and physical activity and to control or reduce obesity. This article summarizes and synthesizes recent reviews and provides examples of representative studies. It also describes ongoing innovative interventions and policy change efforts that were identified through conference presentations, media coverage, and websites. Numerous cross-sectional studies have consistently demonstrated that some attributes of built and food environments are associated with physical activity, healthful eating, and obesity. Residents of walkable neighborhoods who have good access to recreation facilities are more likely to be physically active and less likely to be overweight or obese. Residents of communities with ready access to healthy foods also tend to have more healthful diets. Disparities in environments and policies that disadvantage low-income communities and racial minorities have been documented as well. Evidence from multilevel studies, prospective research, and quasi-experimental evaluations of environmental changes are just beginning to emerge. Environment, policy, and multilevel strategies for improving diet, physical activity, and obesity control are recommended based on a rapidly growing body of research and the collective wisdom of leading expert organizations. A public health imperative to identify and implement solutions to the obesity epidemic warrants the use of the most promising strategies while continuing to build the evidence base.
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            Establishing and maintaining healthy environments. Toward a social ecology of health promotion.

            D Stokols (1991)
            Earlier research on health promotion has emphasized behavior change strategies rather than environmentally focused interventions. The advantages of integrating lifestyle modification, injury control, and environmental enhancement strategies of health promotion are substantial. The author offers a social ecological analysis of health promotive environments, emphasizing the transactions between individual or collective behavior and the health resources and constraints that exist in specific environmental settings. Directions for future research on the creation and maintenance of health promotive environments also are examined.
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              Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren.

              Childhood obesity is a major public health problem in the United States, particularly among American Indian communities. The objective was to evaluate the effectiveness of a school-based, multicomponent intervention for reducing percentage body fat in American Indian schoolchildren. This study was a randomized, controlled, school-based trial involving 1704 children in 41 schools and was conducted over 3 consecutive years, from 3rd to 5th grades, in schools serving American Indian communities in Arizona, New Mexico, and South Dakota. The intervention had 4 components: 1) change in dietary intake, 2) increase in physical activity, 3) a classroom curriculum focused on healthy eating and lifestyle, and 4) a family-involvement program. The main outcome was percentage body fat; other outcomes included dietary intake, physical activity, and knowledge, attitudes, and behaviors. The intervention resulted in no significant reduction in percentage body fat. However, a significant reduction in the percentage of energy from fat was observed in the intervention schools. Total energy intake (by 24-h dietary recall) was significantly reduced in the intervention schools but energy intake (by direct observation) was not. Motion sensor data showed similar activity levels in both the intervention and control schools. Several components of knowledge, attitudes, and behaviors were also positively and significantly changed by the intervention. These results document the feasibility of implementing a multicomponent program for obesity prevention in elementary schools serving American Indian communities. The program produced significant positive changes in fat intake and in food- and health-related knowledge and behaviors. More intense or longer interventions may be needed to significantly reduce adiposity in this population.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                spm
                Salud Pública de México
                Salud pública Méx
                Instituto Nacional de Salud Pública (Cuernavaca )
                0036-3634
                2013
                : 55
                : suppl 3
                : 357-373
                Affiliations
                [1 ] Queen's University Canada
                [2 ] Instituto Nacional de Salud Pública México
                [3 ] Nutrition and Health Sciences
                Article
                S0036-36342013000900003
                e63a1bda-5258-4247-af8e-e56a86a09e6f

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0036-3634&lng=en
                Categories
                Health Policy & Services

                Public health
                nutrition,actividad física,evaluación de efectividad,physical activity,evaluation of the effectiveness of interventions,child nutrition,nutrición infantil,México,obesity /prevention,Mexico,obesidad/prevención

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