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Barriers to the Implementation of Pediatric Overweight and Obesity Guidelines in a School-Based Health Center.
Yeager, LJ, Karp, SM, Leming-Lee, T'
The Nursing clinics of North America. 2019;(1):159-168
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This project applied a quality improvement design to assess perceived barriers to pediatric overweight and obesity guideline implementation in school-based health centers. An electronic survey was administered to nurse practitioners and licensed practical nurses working in school-based health centers in New York. The most commonly cited primary care-based barriers were lack of patient compliance, family lifestyle, and the poor dietary practices and sedentary behaviors common in America. The most commonly cited school-based barriers were that children have little control over the groceries purchased and foods cooked at home and the lack of parent presence during appointments.
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Potential interventions targeting adolescent nutrition in Indonesia: a literature review.
Oddo, VM, Roshita, A, Rah, JH
Public health nutrition. 2019;(1):15-27
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OBJECTIVE The present study aimed to take stock of nutrition interventions that warrant consideration as a minimum package of interventions in Indonesia to improve four key nutrition indicators for adolescents: stunting, thinness, overweight and anaemia. DESIGN We conducted a review of the peer-reviewed literature published between 1995 and 2017 on nutrition-specific and nutrition-sensitive interventions that target adolescents in Indonesia. The search to identify studies was conducted in PubMed, Google Scholar and EMBASE, using key search terms. We also explored programmatic and policy documents from the grey literature as they related to adolescents and/or Indonesia. Our search yielded thirty-five peer-reviewed articles and programmatic documents. SETTING Indonesia. SUBJECTS Adolescent girls and boys. RESULTS There is very limited evidence on the impact of interventions specifically among adolescents in Indonesia. Nevertheless, findings from our review suggest the minimum package of interventions in Indonesia could include the following nutrition-specifc interventions: (i) iron-folic acid supplements, paired with antihelminths delivered at scale via school-based platforms and through health centres; and (ii) diet counselling and nutrition education provided through school-based platforms, adolescent youth centres/peer education and technology-based platforms. The minimum package could also include the following nutrition-sensitive interventions: (i) improving access to reproductive health services; and (ii) increasing the coverage of interventions designed to increase school attendance. CONCLUSIONS Programmes and policies targeting adolescent nutrition are relatively new and coverage is low. To improve the nutritional status of this vulnerable population, additional evaluations of adolescent programming and surveillance data on adolescents are needed.
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Supporting Obesity Prevention in Statewide Quality Rating and Improvement Systems: A Review of State Standards.
Geary, NA, Dooyema, CA, Reynolds, MA
Preventing chronic disease. 2017;:E129
Abstract
INTRODUCTION A quality rating and improvement system (QRIS) is a fundamental component of most states' early care and education infrastructures. States can use a QRIS to set standards that define high-quality care and award child care providers with a quality rating designation based on how well they meet these standards. The objective of this review was to describe the extent to which states' QRIS standards include obesity prevention content. METHODS We collected publicly available data on states' QRIS standards. We compared states' QRIS standards with 47 high-impact obesity prevention components in Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition, and 6 additional topics based on the Centers for Disease Control and Prevention's Spectrum of Opportunities for Obesity Prevention in the Early Care and Education Setting. RESULTS Thirty-eight states operated a state-wide QRIS in early 2015. Of those, 27 states' QRIS included obesity prevention standards; 20 states had at least one QRIS standard that aligned with the high-impact obesity prevention components, and 21 states had at least one QRIS standard that aligned with at least one of the 6 additional topics. QRIS standards related to the physical activity high-impact obesity prevention components were the most common, followed by components for screen time, nutrition, and infant feeding. CONCLUSION The high proportion of states operating a QRIS that included obesity prevention standards, combined with the widespread use of QRISs among states, suggests that a QRIS is a viable way to embed obesity prevention standards into state early care and education systems.
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Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews.
Guerra, PH, da Silveira, JA, Salvador, EP
Jornal de pediatria. 2016;(1):15-23
Abstract
OBJECTIVE To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents. DATA SOURCE Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed. SUMMARY OF THE FINDINGS Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation. CONCLUSIONS Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.
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Using the ANGELO model to develop the children's healthy living program multilevel intervention to promote obesity preventing behaviors for young children in the U.S.-affiliated Pacific Region.
Braun, KL, Nigg, CR, Fialkowski, MK, Butel, J, Hollyer, JR, Barber, LR, Bersamin, A, Coleman, P, Teo-Martin, U, Vargo, AM, et al
Childhood obesity (Print). 2014;(6):474-81
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BACKGROUND Almost 40% of children are overweight or obese by age 8 years in the US-Affiliated Pacific, inclusive of the five jurisdictions of Alaska, Hawaii, American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands. This article describes how the Children's Healthy Living (CHL) Program used the ANGELO (Analysis Grid for Environments/Elements Linked to Obesity) model to design a regional intervention to increase fruit and vegetable intake, water consumption, physical activity, and sleep duration and decrease recreational screen time and sugar-sweetened beverage consumption in young children ages 2-8 years. METHODS Using the ANGELO model, CHL (1) engaged community to identify preferred intervention strategies, (2) reviewed scientific literature, (3) merged findings from community and literature, and (4) formulated the regional intervention. RESULTS More than 900 community members across the Pacific helped identify intervention strategies on importance and feasibility. Nine common intervention strategies emerged. Participants supported the idea of a regional intervention while noting that cultural and resource differences would require flexibility in its implementation in the five jurisdictions. Community findings were merged with the effective obesity-reducing strategies identified in the literature, resulting in a regional intervention with four cross-cutting functions: (1) initiate or strengthen school wellness policies; (2) partner and advocate for environmental change; (3) promote CHL messages; and (4) train trainers to promote CHL behavioral objectives for children ages 2-8 years. These broad functions guided intervention activities and allowed communities to tailor activities to maximize intervention fit. CONCLUSIONS Using the ANGELO model assured that the regional intervention was evidence based while recognizing jurisdiction context, which should increase effectiveness and sustainability.
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Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review.
Verstraeten, R, Roberfroid, D, Lachat, C, Leroy, JL, Holdsworth, M, Maes, L, Kolsteren, PW
The American journal of clinical nutrition. 2012;(2):415-38
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BACKGROUND The prevalence of childhood obesity is increasing rapidly in low- and middle-income countries, and informed policies to tackle the problem must be defined. OBJECTIVE We systematically reviewed the evidence on the effectiveness of school-based interventions targeting dietary behavior and/or physical activity for the primary prevention of obesity in children and adolescents aged 6-18 y in low- and middle-income countries. DESIGN We searched the MEDLINE, EMBASE, Web of Science, CENTRAL, ERIC, Cochrane Library, and Centre for Reviews and Dissemination databases for peer-reviewed controlled studies published in English, Spanish, French, German, or Dutch between January 1990 and July 2011. The quality of the included studies was appraised independently by 2 authors who used the Effective Public Health Practice Project tool. RESULTS From a total of 7218 unique references, we retained 22 studies. Most of the interventions (82%) had a positive effect on dietary behavior and physical activity behavior (effect size ranged from -0.48 to 1.61). BMI decreased in 8 studies (effect size ranged from -0.7 to 0.0). Effective interventions targeted both diet and physical activity, involved multiple stakeholders, and integrated educational activities into the school curriculum. CONCLUSIONS School-based interventions have the potential to improve dietary and physical activity behavior and to prevent unhealthy body weights in low- and middle-income countries. To reach their full potential, interventions should conduct process evaluations to document program implementation. The effect and the pathways through which interventions have this effect need to be better documented through rigorous evaluation studies.
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School-based obesity prevention programs: an evidence-based review.
Kropski, JA, Keckley, PH, Jensen, GL
Obesity (Silver Spring, Md.). 2008;(5):1009-18
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OBJECTIVE This review seeks to examine the effectiveness of school-based programs for reducing childhood overweight or obesity. METHODS AND PROCEDURES A systematic review of the research literature published since 1990 was conducted to identify experimental or quasi-experimental school-based curricular or environmental preventive interventions, with evaluation>or=6 months after baseline, which reported outcomes in terms of a measure of overweight. RESULTS Fourteen studies were identified, including one involving a nutrition-only program, two physical activity promotion interventions and eleven studies combining nutrition and physical activity components. Most studies (n=10) offered weak (grade 2) quality evidence. One study offered strong (grade 4) evidence reducing the odds ratio for overweight in girls only, while four grade 2 studies reported significant improvements in BMI or at-risk-for overweight or overweight prevalence in boys, girls, or both. Twelve studies reported significant improvement in at least one measure of dietary intake, physical activity, and/or sedentary behavior. DISCUSSION Our ability to draw strong conclusions as to the efficacy of school-based obesity prevention programs is limited by the small number of published studies and by methodological concerns. Qualitative analysis suggests programs grounded in social learning may be more appropriate for girls, while structural and environmental interventions enabling physical activity may be more effective for boys. High-quality evaluation protocols should be considered essential components of future programs.
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Realist review to understand the efficacy of school feeding programmes.
Greenhalgh, T, Kristjansson, E, Robinson, V
BMJ (Clinical research ed.). 2007;(7625):858-61
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A recent Cochrane review found that school feeding programmes significantly improve the growth and cognitive performance of disadvantaged children. Trisha Greenhalgh,Elizabeth Kristjansson, and Vivian Robinson look more closely at the highly heterogeneous trials to see what works, for whom, and in what circumstances