Barcelona, 3 September 2006:
The prevalence of obesity among children is increasing worldwide. Today, more than 20 billion obese children are living in the European Union. Obese children tend to become obese adults, and often have concomitant co-morbidities such as hypertension (more than 30%), hyperlipoproteinaemia ( more than 25%), diabetes mellitus type 2 (1%) etc. The need for preventive and therapeutic measures, therefore, is of undoubted importance, but the best way to deliver interventions to children is not known.
The StEP TWO (Sport, Ernährung = nutrition, Prevention TWO) is the second step of our Children’s Health InterventionaL Trial (CHILT) project. StEP TWO is a new attempt to transfer the experience of interdisciplinary out-patient family-based programmes for obese children into primary schools.
The programme targeted young, overweight children (≥ 6 years). It was developed in 2003 for overweight and obese children and it consists of extra lessons about healthy nutrition, and physical education. It is based on the modification of dietary intake, physical exercise, and behavioural therapy and aims to reduce body mass index by weight maintenance, increased physical activity, and improving motor abilities.
The school-based part started directly after school. Nutritionists, gymnasts and medical doctors taught the children in each of their respective fields. The nutritionists cooked and ate with the children twice a week. After the meal, the children participated in a physical activity programme lasting between 60 and 90 minutes. Parents were involved in six information evenings according to medical, psycho-social and nutritional topics and two family events (Inline skating together).
We evaluated the effect on the body mass index (BMI), and blood pressure in 40 children undergoing intervention compared with 74 children who were invited and therefore screened, but did not take part in the intervention, the so-called non-participants, and 145 controls from four other primary schools.
Main results
Body mass index increased significantly in the non-participants (+ 0,5 kg/m²) and the control group (+ 0,7 kg/m²) compared with baseline measurements, but not in those selected for intervention (+ 0,3 kg/m²).
The change in body mass index was analysed separately in overweight and obese children. Both overweight and obese children benefitted from the intervention. Among the non-participants, obese children increased their body mass index more markedly than the overweight children. Within the controls the increase was seen in both obese and overweight children (see fig.1) .Systolic blood pressure decreased most in those selected for intervention group (ca. – 10 mmHg), less in the non-participants (ca. - 6 mmHg), but not in the controls. A similar pattern was observed according to diastolic blood pressure values, decrease in the intervention children ca. – 3 mmHg, non-participants ca. –2 mmHg, no decrease in the controls.
Conclusion
Our data confirms the efficacy of early preventive measures for overweight and obese children at their primary schools. The screening itself, demonstrated in the group of non-participants, seems also to have a minor positive effect, but only for overweight children.Therefore, this interdisciplinary programme is a helpful preventive measure for overweight and obese children and their families and should be implemented in primary schools.Fig. 1 Increase of the BMI (in kg/m²) in obese and overweight children in the intervention group (IG), non-participants (NP) and control group (CG).