Effectiveness of a Universal Parental Support Programme to Promote Healthy Dietary Habits and Physical Activity and to Prevent Overweight and Obesity in 6-Year-Old Children: The Healthy School Start Study, a Cluster-Randomised Controlled Trial

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Abstract

Objective

To develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in Swedish children.

Methods

A cluster-randomised controlled trial was carried out in areas with low to medium socio-economic status. Participants were six-year-old children (n = 243) and their parents. Fourteen pre-school classes were randomly assigned to intervention (n = 7) and control groups (n = 7). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary and physical activity habits and parental self-efficacy through a questionnaire. Body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 6-months follow-up. Group differences were examined using analysis of covariance and Poisson regression, adjusted for gender and baseline values.

Results

There was no significant intervention effect in the primary outcome physical activity. Sub-group analyses showed a significant gender-group interaction in total physical activity (TPA), with girls in the intervention group demonstrating higher TPA during weekends (p = 0.04), as well as in sedentary time, with boys showing more sedentary time in the intervention group (p = 0.03). There was a significantly higher vegetable intake (0.26 servings) in the intervention group compared to the control group (p = 0.003). At follow-up, sub-group analyses showed a sustained effect for boys. The intervention did not affect the prevalence of overweight or obesity.

Conclusions

It is possible to influence vegetable intake in children and girls’ physical activity through a parental support programme. The programme needs to be intensified in order to increase effectiveness and sustain the effects long-term. These findings are an important contribution to the further development of evidence-based parental support programmes to prevent overweight and obesity in children.

Trial Registration

Controlled-trials.com ISRCTN32750699

Related collections

Most cited references 45

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A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

Stephen S Lim, Theo Vos, Abraham D. Flaxman … (2012)

The Lancet, 380(9859), 2224-2260

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Interventions for preventing obesity in children.

Elizabeth Waters, Andrea M de Silva-Sanigorski, Belinda Hall … (2011)

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required. Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I(2)=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m(2) (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:· school curriculum that includes healthy eating, physical activity and body image· increased sessions for physical activity and the development of fundamental movement skills throughout the school week· improvements in nutritional quality of the food supply in schools· environments and cultural practices that support children eating healthier foods and being active throughout each day· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activitiesHowever, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

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Tracking of Physical Activity from Childhood to Adulthood: A Review

Risto Telama (2009)

The aim of the article was to review studies on the tracking of physical activity in all phases of life from childhood to late adulthood. The majority of the studies have been published since 2000. The follow-up time in most studies was short, the median being 9 years. In men, the stability of physical activity was significant but low or moderate during all life phases and also in longterm follow-ups. In women, the tracking was lower and in many cases non-significant. Among both sexes, stability seems to be lower in early childhood than in adolescence or in adulthood and lower in transitional phases, such as from childhood to adolescence or from adolescence to adulthood, than in adulthood. However, the differences in the stability of physical activity between age groups and between different phases of life were small. The number of tracking studies utilising objective methods to measure physical activity was so small that systematic differences in stability between self-report and objective methods could not be determined. A factor which caused differences in tracking results was the adjustment of correlations for measurement error and other error variance. Adjusted coefficients were clearly higher than unadjusted ones. However, adjustment was done only in very few studies. If the different methods used for estimating habitual physical activity and the failure to control for important covariates in studies of tracking are taken into account, physical activity appears to track reasonably well also in the longer term, for example from adolescence to adulthood. The results of the tracking studies support the idea that the enhancement of physical activity in children and adolescents is of great importance for the promotion of public health.

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Author and article information

Contributors

James Coyne: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 13 February 2015

Publication date Collection: 2015

Volume: 10

Issue: 2

Electronic Location Identifier: e0116876

Affiliations

[1 ]Karolinska Institutet, Department of Public Health Sciences, Tomtebodavägen 18 A, 171 65 Solna, Sweden

[2 ]Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden

[3 ]Karolinska Institutet, Department of Clinical Neuroscience, Nobels väg 9, 171 65 Solna, Sweden

[4 ]Karolinska Institutet, Institute of Environmental Medicine, Box 210, 171 77 Stockholm, Sweden

University of Pennsylvania, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: GN ES ÅN LSE. Performed the experiments: GN ES ÅN. Analyzed the data: GN ÅN BB JH. Contributed reagents/materials/analysis tools: GN ES ÅN BB JH LSE. Wrote the paper: GN ES ÅN BB JH LSE.

* E-mail: gisela.nyberg@ 123456ki.se

Article

Publisher ID: PONE-D-14-27012

DOI: 10.1371/journal.pone.0116876

PMC ID: 4332680

PubMed ID: 25680096

SO-VID: 88cda676-5e0c-4a26-9141-b79f57af8216

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Page count

Figures: 1, Tables: 4, Pages: 19

Funding

ES and LSE received funding for this study from the Public Health Fund, Stockholm County Council. GN received funding from the Signhild Engkvist Foundation, the Martin Rind Foundation and the Lars Hierta Memorial Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Ethical restrictions prevent this data from being deposited in a public repository. The data are available upon request and can be requested from the corresponding author Dr. Gisela Nyberg ( gisela.nyberg@ 123456ki.se ).

Effectiveness of a Universal Parental Support Programme to Promote Healthy Dietary Habits and Physical Activity and to Prevent Overweight and Obesity in 6-Year-Old Children: The Healthy School Start Study, a Cluster-Randomised Controlled Trial

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Most cited references 45

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

Interventions for preventing obesity in children.

Tracking of Physical Activity from Childhood to Adulthood: A Review

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