Pediatric Weight Management

PWM: School-based Interventions (2011)

The School-based Intervention questions below update the questions previously published (2003-4) in the Childhood Overweight project.

While forty-four (44) unique research articles were abstracted and summarized to formulate the previously published school-based intervention conclusions, the workgroup decided to rely on systematic reviews for the update.

• Assessment
  In school-based programs, what is the effectiveness of nutrition education as a part of an intervention program to address childhood overweight?

  • Conclusion

    There is insufficient evidence to draw conclusions about the effectiveness of school-based nutrition education interventions alone to address adiposity in children.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: School-Based Nutrition Education Programs and Childhood Adiposity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev. 2009 Jan; 10(1): 110-141. Epub: 2008 Jul 30. Review.
      • Connelly JB, Duaso MJ, Butler G. A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: A realistic synthesis of the evidence. Public Health. 2007; 121: 510-517.
      • Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity 2008; 16: 1,009-1,018
  • Search Plan and Results: Update to School-Based Intervention Programs: Nutrition Education Interventions 2009
     
  In school-based programs, what is the effectiveness of altering physical activity patterns as a part of an intervention program to address childhood overweight?

  • Conclusion

    The use of school-based physical activity programs alone is unlikely to bring about improvement in measures of adiposity in school-aged children.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: School-Based Physical Activity Programs and Childhood Adiposity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Beets MW, Beighle A, Erwin HE, Huberty JL. After-school program impact on physical activity and fitness: A meta-analysis. Am J Prev Med. 2009 Jun; 36(6): 527-537.
      • Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev. 2009 Jan; 10(1): 110-141. Epub: 2008 Jul 30. Review.
      • Dobbins M, De Corby K, Robeson P, Husson H, Tirilis D. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged six to 18. Cochrane Database Syst Rev. 2009 Jan 21; (1): CD007651.
      • Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: A meta-analysis. CMAJ. 2009 Mar 31;180(7): 719-726. 
      • Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity 2008; 16: 1,009-1,018
  • Search Plan and Results: Update to School-Based Intervention Programs: Physical Activity Interventions 2009
     
  In school-based programs, what is the effectiveness of combined nutrition education and physical activity interventions to address childhood overweight?

  • Conclusion

    School-based programs that combined both a physical activity and a nutrition education component were diverse, combining different types of interventions for different lengths of time.

    Multi-component school-based programs that include at least physical activity and nutrition education interventions may be effective in improving adiposity measures, though results appear to be heavily dependent on a wide range of program design factors, population and context.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: School-Based Programs Combining Physical Activity and Nutrition Education Components and Childhood Adiposity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev. 2009 Jan; 10(1): 110-141. Epub: 2008 Jul 30. Review.
      • Connelly JB, Duaso MJ, Butler G. A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: A realistic synthesis of the evidence. Public Health. 2007; 121: 510-517.
      • Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: A meta-analysis. CMAJ. 2009 Mar 31;180(7): 719-726. 
      • Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity 2008; 16: 1,009-1,018
  • Search Plan and Results: POW: Update to School-Based Intervention Programs: Combined Physical Activity and Nurition Education Interventions
     
  Among systematic reviews that reported on anthropometric outcomes and also reported on behavioral outcomes of school-based interventions, what is the effectiveness of school-based physical activity programs for bringing about improvements in behaviors related to childhood overweight and obesity?

  • Conclusion

    Among systematic reviews that reported on anthropometric outcomes and also reported on behavioral outcomes, school-based physical activity programs alone may be successful in increasing time spent in physical activity and reducing screen time.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: School-Based Physical Activity Programs and Behaviors Related to Childhood Overweight and Obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Beets MW, Beighle A, Erwin HE, Huberty JL. After-school program impact on physical activity and fitness: A meta-analysis. Am J Prev Med. 2009 Jun; 36(6): 527-537.
      • Dobbins M, De Corby K, Robeson P, Husson H, Tirilis D. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged six to 18. Cochrane Database Syst Rev. 2009 Jan 21; (1): CD007651.
      • Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity 2008; 16: 1,009-1,018
• Intervention
  Among systematic reviews that reported on anthropometric outcomes and also reported on behavioral outcomes of school-based interventions, what is the effectiveness of school-based programs that include physical activity and nutrition education components for bringing about improvements in behaviors related to childhood overweight and obesity?

  • Conclusion

    Few systematic reviews that reported on anthropometric outcomes also reported on behavioral outcomes of school-based interventions that combined nutrition education and physical activity. However, among those that did, studies demonstrated improvement on at least one behavior associated with childhood overweight, such as increased physical activity, increased fruit and vegetable intake, decrease in sedentary behaviors, and so on

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: School-Based Programs Combining Physical Activity and Nutrition Education Components and Behaviors Related to Childhood Overweight and Obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity 2008; 16: 1,009-1,018
  • Search Plan and Results: POW: Update to School-Based Intervention Programs: Combined Physical Activity and Nurition Education Interventions
     
  Among systematic reviews that reported on anthropometric outcomes and also reported on behavioral outcomes of school-based interventions, what is the effectiveness of school-based nutrition education programs for bringing about improvements in behaviors related to childhood overweight and obesity?

  • Conclusion

    There is insufficient evidence to draw conclusions about the effectiveness of school-based nutrition education interventions alone to address behaviors related to overweight and obesity in children.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: School-Based Nutrition Education Programs and Behaviors Related to Childhood Overweight and Obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity 2008; 16: 1,009-1,018