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A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years

A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years
A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years
Background: Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness.

Methods: A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score.

Results: Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n=22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n=26) included strategies such as environment modifications (n=10), digital interventions (n=15) and parent involvement (n=16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (-0.06 [95% CI -0.10, -0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated.

Conclusions: Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.
Adolescent health, Body mass index, Diet, Health education, Intervention, Nutrition, Obesity, Physical activity, School
1479-5868
Jacob, Chandni Maria
f72c15ac-ef6b-4144-95b3-31194541fe00
Hardy-Johnson, Polly
49276c2f-01a9-4488-9f30-dc359cf867e0
Inskip, Hazel
5fb4470a-9379-49b2-a533-9da8e61058b7
Morris, Taylor
ad05dc29-02db-434e-8f06-e88bf09d5adb
Parsons, Camille
9730e5c3-0382-4ed7-8eaa-6932ab09ec15
Barrett, Millie
aa089b2d-e57c-4d7a-b047-f95b53a4cb72
Hanson, Mark
1952fad1-abc7-4284-a0bc-a7eb31f70a3f
Woods-Townsend, Kathryn
af927fa3-30b6-47d9-8b4d-4d254b3a7aab
Baird, Janis
f4bf2039-6118-436f-ab69-df8b4d17f824
Jacob, Chandni Maria
f72c15ac-ef6b-4144-95b3-31194541fe00
Hardy-Johnson, Polly
49276c2f-01a9-4488-9f30-dc359cf867e0
Inskip, Hazel
5fb4470a-9379-49b2-a533-9da8e61058b7
Morris, Taylor
ad05dc29-02db-434e-8f06-e88bf09d5adb
Parsons, Camille
9730e5c3-0382-4ed7-8eaa-6932ab09ec15
Barrett, Millie
aa089b2d-e57c-4d7a-b047-f95b53a4cb72
Hanson, Mark
1952fad1-abc7-4284-a0bc-a7eb31f70a3f
Woods-Townsend, Kathryn
af927fa3-30b6-47d9-8b4d-4d254b3a7aab
Baird, Janis
f4bf2039-6118-436f-ab69-df8b4d17f824

Jacob, Chandni Maria, Hardy-Johnson, Polly, Inskip, Hazel, Morris, Taylor, Parsons, Camille, Barrett, Millie, Hanson, Mark, Woods-Townsend, Kathryn and Baird, Janis (2021) A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years. International Journal of Behavioral Nutrition and Physical Activity, 18 (1), [1]. (doi:10.1186/s12966-020-01065-9).

Record type: Article

Abstract

Background: Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness.

Methods: A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score.

Results: Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n=22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n=26) included strategies such as environment modifications (n=10), digital interventions (n=15) and parent involvement (n=16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (-0.06 [95% CI -0.10, -0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated.

Conclusions: Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.

Text
Manuscript revised CLEAN submission IJBNPA 17.11.2020 - Accepted Manuscript
Restricted to Repository staff only until 4 January 2022.
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Accepted/In Press date: 30 November 2020
e-pub ahead of print date: 7 January 2021
Keywords: Adolescent health, Body mass index, Diet, Health education, Intervention, Nutrition, Obesity, Physical activity, School

Identifiers

Local EPrints ID: 446559
URI: http://eprints.soton.ac.uk/id/eprint/446559
ISSN: 1479-5868
PURE UUID: 7f3112d1-dbdd-4aa1-83ac-69e23be4a604
ORCID for Chandni Maria Jacob: ORCID iD orcid.org/0000-0002-2024-0074
ORCID for Hazel Inskip: ORCID iD orcid.org/0000-0001-8897-1749
ORCID for Mark Hanson: ORCID iD orcid.org/0000-0002-6907-613X
ORCID for Kathryn Woods-Townsend: ORCID iD orcid.org/0000-0003-3376-6988
ORCID for Janis Baird: ORCID iD orcid.org/0000-0002-4039-4361

Catalogue record

Date deposited: 15 Feb 2021 17:31
Last modified: 18 Feb 2021 17:30

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Contributors

Author: Polly Hardy-Johnson
Author: Hazel Inskip ORCID iD
Author: Taylor Morris
Author: Camille Parsons
Author: Millie Barrett
Author: Mark Hanson ORCID iD
Author: Janis Baird ORCID iD

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