Background
Childhood overweight and obesity is an ever increasing
public health concern [1] which has serious health consequences
in both child [2] and adult life [3]. Children
as young as 7 years old, who are obese, are at higher risk
of premature mortality in adulthood, compared to their
normal weight counterparts [4] and from the age of
11 years, there is tracking of behaviours [5], such that
over 50% of obese children become obese adults [6]. In
England childhood obesity rates have increased over the
last 20 years. A doubling of prevalence of obesity can be
observed between the ages of 4 and 11 years (the primary
school years) [7]. This is the time period of adiposity rebound,
which occurs following a nadir in Body Mass
Index (BMI) around the age of 5–6 years [8]. Thus the primary
school years are a key time period for targeting interventions
for the prevention of childhood obesity. In
terms of settings, schools are an environment in which
the majority of children spend a sustained period of time.
They provide an infrastructure through which children
and their parents can be identified and receive, both
within and outside the curriculum, opportunities to learn
about, practice and reinforce healthy lifestyle behaviours.
Several systematic reviews [9-11] have summarised the
outcomes of previous childhood obesity prevention studies,
undertaken in a variety of settings including school,
community and family. The most up-to-date Cochrane
review of trials, published in 2011, showed that school
based interventions, particularly those targeting 6–12
year olds, are effective in reducing adiposity (mean effect
size −0.15 for BMI z-score). However, there was much
heterogeneity in intervention components and design and
generally small sample sizes. Furthermore previous trials
were poor at reporting process and implementation measures,
rarely considered equity of effects in relation to sex,
ethnicity or other subgroups, tended not to report longer
term outcomes and seldom reported on adverse effects or
costs.
BackgroundChildhood overweight and obesity is an ever increasingpublic health concern [1] which has serious health consequencesin both child [2] and adult life [3]. Childrenas young as 7 years old, who are obese, are at higher riskof premature mortality in adulthood, compared to theirnormal weight counterparts [4] and from the age of11 years, there is tracking of behaviours [5], such thatover 50% of obese children become obese adults [6]. InEngland childhood obesity rates have increased over thelast 20 years. A doubling of prevalence of obesity can beobserved between the ages of 4 and 11 years (the primaryschool years) [7]. This is the time period of adiposity rebound,which occurs following a nadir in Body MassIndex (BMI) around the age of 5–6 years [8]. Thus the primaryschool years are a key time period for targeting interventionsfor the prevention of childhood obesity. Interms of settings, schools are an environment in whichthe majority of children spend a sustained period of time.They provide an infrastructure through which childrenand their parents can be identified and receive, bothwithin and outside the curriculum, opportunities to learnabout, practice and reinforce healthy lifestyle behaviours.Several systematic reviews [9-11] have summarised theoutcomes of previous childhood obesity prevention studies,undertaken in a variety of settings including school,community and family. The most up-to-date Cochranereview of trials, published in 2011, showed that schoolbased interventions, particularly those targeting 6–12year olds, are effective in reducing adiposity (mean effectsize −0.15 for BMI z-score). However, there was muchheterogeneity in intervention components and design andgenerally small sample sizes. Furthermore previous trialswere poor at reporting process and implementation measures,rarely considered equity of effects in relation to sex,ethnicity or other subgroups, tended not to report longerterm outcomes and seldom reported on adverse effects orcosts.
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