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      Impact of a one-year school-based teacher-implemented nutrition and physical activity intervention: main findings and future recommendations

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          Abstract

          Background

          The aim of the current study is to describe the effectiveness of a school-based intervention when delivered by a non-nutrition specialist (trained schoolteachers) as compared to an expert in nutrition.

          Methods

          Two trials of the same school-based intervention using the same intervention package were delivered, one by nutritionists and another by trained schoolteachers. The intervention focused mainly on dietary behaviours, as well as physical activity. In both trials, purposively selected schools were randomized to intervention or control groups; students (aged 9–11 years) in both groups were compared at post-test on knowledge and self-efficacy scores, as well as dietary and physical activity behaviours, controlling for their baseline status on the various measures. All analyses accounted for clustering at the school level.

          Results

          In both trials, a statistically significantly greater improvement was observed for both the knowledge and self-efficacy scores in intervention vs. school students. When the programme was delivered by trained schoolteachers, frequency of breakfast intake was increased, crisps consumption was reduced, but no change in fruit and vegetable consumption was observed (latter increased when delivered by nutrition professionals only). Physical activity did not improve in both trials.

          Conclusion

          Trained schoolteachers can have a positive impact on students’ dietary behaviours with the appropriate training to ensure they are equipped with the right information, skills, and resources to deliver the programme with the highest fidelity.

          Trial registration

          ClinicalTrial.gov Identifier: NCT03040271. Retrospectively registered on 2 February 2017.

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          Most cited references28

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          Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

          In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Overweight and Obesity in Eastern Mediterranean Region: Prevalence and Possible Causes

            The objective of this paper was to explore the prevalence of overweight and obesity among various age groups as well as discuss the possible factors that associated with obesity in the Eastern Mediterranean Region (EMR). A systematic review of published papers between 1990 and 2011 was carried out. Obesity reached an alarming level in all age groups of the EMR countries. The prevalence of overweight among preschool children(<5 years) ranged from 1.9% to 21.9%, while the prevalence of overweight and obesity among school children ranged from 7% to 45%. Among adults the prevalence of overweight and obesity ranged from 25% to 81.9%. Possible factors determining obesity in this region include: nutrition transition, inactivity, urbanization, marital status, a shorter duration of breastfeeding, frequent snacking, skipping breakfast, a high intake of sugary beverages, an increase in the incidence of eating outside the home, long periods of time spent viewing television, massive marketing promotion of high fat foods, stunting, perceived body image, cultural elements and food subsidize policy. A national plan of action to overcome obesity is urgently needed to reduce the economic and health burden of obesity in this region.
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              Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health.

              To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grades 6 to 8. Randomized, controlled field trial with 5 intervention and 5 control schools. Outcomes were assessed using preintervention (fall 1995) and follow-up measures (spring 1997), including prevalence, incidence, and remission of obesity. A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities. Students participated in a school-based interdisciplinary intervention over 2 school years. Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education. Sessions focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity. Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles. Because schools were randomized, rather than students, the generalized estimating equation method was used to adjust for individual-level covariates under cluster randomization. The prevalence of obesity among girls in intervention schools was reduced compared with controls, controlling for baseline obesity (odds ratio, 0.47; 95% confidence interval, 0.24-0.93; P = .03), with no differences found among boys. There was greater remission of obesity among intervention girls vs. control girls (odds ratio, 2.16; 95% confidence interval, 1.07-4.35; P = .04). The intervention reduced television hours among both girls and boys, and increased fruit and vegetable consumption and resulted in a smaller increment in total energy intake among girls. Reductions in television viewing predicted obesity change and mediated the intervention effect. Among girls, each hour of reduction in television viewing predicted reduced obesity prevalence (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; P = .02). Planet Health decreased obesity among female students, indicating a promising school-based approach to reducing obesity among youth.
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                Author and article information

                Contributors
                ch18@aub.edu.lb
                lg01@aub.edu.lb
                cm35@aub.edu.lb
                naa55@mail.aub.edu
                md82@aub.edu.lb
                nahla@aub.edu.lb
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                19 February 2020
                19 February 2020
                2020
                : 20
                : 256
                Affiliations
                [1 ]ISNI 0000 0004 1936 9801, GRID grid.22903.3a, Department of Nutrition and Food Sciences, , American University of Beirut, ; Riad El-Solh, Beirut, 1107-2020 Lebanon
                [2 ]ISNI 0000 0004 1936 9801, GRID grid.22903.3a, Department of Epidemiology and Population Health, , American University of Beirut, ; Riad El-Solh, Beirut, 1107-2020 Lebanon
                Article
                8351
                10.1186/s12889-020-8351-3
                7031897
                32075607
                a406f7b4-e336-41e2-a8ff-18f385f52661
                © The Author(s). 2020

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 March 2019
                : 13 February 2020
                Funding
                Funded by: Nestlé Middle East
                Award ID: 100119
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Public health
                obesity,school nutrition,school-based intervention,schoolchildren,lebanon,overweight,school policy,sustainability

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