Health, diet education during elementary school years may mitigate progression of obesity
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Key takeaways:
- A health education-based intervention reduced progression of obesity markers in children.
- The benefit was most pronounced among children who entered the program in the first grade.
Early initiation of a school-based health education intervention limited adiposity marker progression in elementary-aged children in Spain, researchers reported.
The main results of the SI! program in Spain were published in the Journal of the American College of Cardiology.
“School-based health promotion initiatives are increasingly considered critical for promoting children’s and adolescents’ health, well-being, and development through comprehensive programs promoting a healthy school environment, health and nutrition literacy, physical activity, and emotional health,” Gloria Santos-Beneit, PhD, of the Foundation for Science, Health and Education (Fundación SHE) in Barcelona, Spain, and the National Centre for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]) in Madrid, and colleagues wrote. “However, the results of most initiatives of this kind have been inconclusive, particularly regarding the impact of timing on intervention effects.”
This analysis of the SI! program evaluated the effects of time-varying exposures to a school-based health intervention on markers of adiposity.
The SI! program is a multicomponent intervention trial designed to instill healthy habits from early childhood. It has been implemented in schools in Spain, Colombia and the U.S.
The intervention includes education on diet, physical activity, body and heart and emotional management, according to the study.
For the present analysis, 48 schools in Madrid were randomly assigned to the SI! program or standard curriculum.
Twelve elementary education grades first to sixth (459 children), 12 elementary grades first to third (513 children) and 12 elementary grades fourth to sixth (419 children) were assigned to the SI! program and 12 control elementary schools received the standard curriculum (379 children).
The primary endpoint was 3- and 6-year differences in markers of adiposity and the overall knowledge-attitudes-habits score between the intervention and control arms.
Benefits of SI! on markers of obesity in children
At 3 years, elementary school children who received the SI! program intervention had lower increases in z scores for BMI (0.09; 95% CI, 0.16 to 0.03; P = .003) and waist-to-height ratio and waist circumference (0.19; 95% CI, 0.28 to 0.1; P < .001), from baseline compared with the control group.
The observed benefits trend in z scores of waist-to-height ratio and waist circumference was maintained out to 6 years for the groups that initiated the SI! program intervention earliest:
- waist circumference z score in controls vs. grades first to sixth (0.19; P = .02);
- waist circumference z score in controls vs. grades first to third (0.22; P = .009);
- waist-to-height ratio z score in controls vs. grades first to sixth (0.24; P = .009); and
- waist-to-height ratio z score in controls vs. grades first to third (0.29; P = .001).
The researchers reported no significant differences in the change of overall knowledge-attitudes-habits score between the intervention and control groups.
“This is one of [the] largest and longest follow-up randomized trials reported to date on school-based health promotion interventions,” the researchers wrote. “In the present randomized trial, two of the three intervention groups (E1-3 and E1-6) showed significant favorable changes in z score for waist circumference and z score for waist-to- height ratio vs. the control group. These adiposity markers are strongly associated with CV health in children and adults. ... The effect of school-based interventions on children’s health will likely be more sustainable if they are started as early as possible and include reinterventions to reinforce key messages for families until children become more independent.”
In the words of Valentin Fuster
In a related editorial, Carl J. Lavie Jr., MD, FACC, FACP, FCCP, medical director of cardiac rehabilitation and prevention and director of exercise laboratories at John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine in New Orleans, and colleagues discussed the prevalence of overweight and obesity among very young children and the importance of early health education.
“Even earlier in life (ie, preschool age 3-5 years), the prevalence of overweight or obesity is already very high, and it is 35% in the case of Spain,” the authors wrote. “This finding suggests that we, as a society, are already doing something wrong in the first 2 years of life, and a future research question is what type of policy strategies and intervention could attempt to tackle this problem very early in life.
“The long-term editor-in-chief of JACC and the senior author on this study, Dr. Valentin Fuster, recently stated in his Editor’s Page that ‘we believe that the education of children (and their parents and families) is where we as CVD physicians and researchers can have the greatest effect on lowering the rate of CVD globally,”’ they wrote. “The results of this present intervention study of school-aged children to prevent progression of obesity and potentially cardiometabolic issues leading to CVD provide an excellent start to prevent CVD earlier — a paradigm shift indeed.”
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