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Cover page of the Journal of Health Sciences


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 146-150

Effect of school-based intervention program for children with obesity: A randomized control trial


Department of Paediatric Physiotherapy, KLEU Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Web Publication18-May-2018

Correspondence Address:
Dr. Deepa C Metgud
Department of Paediatric Physiotherapy, KLEU Institute of Physiotherapy, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_68_17

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  Abstract 


INTRODUCTION: Obesity in childhood is a major health issue that is seen in both developed and developing countries. Childhood obesity is associated with high risk of adulthood obesity and a series of health problems such as insulin resistance, hypertension, hyperlipidemia, type II diabetes mellitus, sleep apnea, and psychosocial problems. With the social development and changes in lifestyles, currently children and adolescents are lacking physical activity.
METHODOLOGY: This study was a randomized control trial. One thousand one hundred and sixty-five students were screened aged 6–12 years. Among the screened children, 32 obese children were recruited in the study and randomly allocated into Groups A (n = 16) and B (n = 16). Group A received structured school-based physical activity intervention and Group B received physical activity of child's choice of 45 min for 6 days/week for 4 weeks in addition to health education.
RESULTS: The mean age difference of the participants between the Groups A and B was 0.12 ± 0.08 years. There were significant changes in weight, body mass index (BMI), and skinfold thickness scores. The mean difference in weight, BMI, and skinfold thickness between the group was 0.43 ± 1.17, 1.1 ± 0.46, and 6.61 ± 3.29, respectively.
CONCLUSION: The present study concluded that both the types of school-based physical activity interventions are equally effective in reducing weight, BMI, and skinfold thickness scores. However, structured physical activity showed a better reduction in mean weight at the end of 2 weeks of intervention and nonstructured physical activity showed a better reduction in mean weight at 4 weeks of intervention.

Keywords: Children, obesity, physical activity, school-based intervention


How to cite this article:
Metgud DC, Hungund AA, Kulkarni AA. Effect of school-based intervention program for children with obesity: A randomized control trial. Indian J Health Sci Biomed Res 2018;11:146-50

How to cite this URL:
Metgud DC, Hungund AA, Kulkarni AA. Effect of school-based intervention program for children with obesity: A randomized control trial. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2020 Feb 25];11:146-50. Available from: http://www.ijournalhs.org/text.asp?2018/11/2/146/232696




  Introduction Top


Obesity is one of the major health problems worldwide. It is also the most neglected public health condition. Childhood obesity is a health issue seen in both developed and developing countries. According to the World Health Organization (WHO), obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. Childhood obesity is associated with high risk of adulthood obesity and a series of health problems such as insulin resistance, hypertension, hyperlipidemia, type II diabetes mellitus, sleep apnea, gallbladder disease, and psychosocial problems.[1],[2]

Children with body mass index (BMI) above the 95th percentile are termed as obese. The fundamental cause of obesity is an energy imbalance between calories consumed and expended. There is an increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals, and other healthy micronutrients. There is a noticeable trend toward decreased physical activity levels, which is due to the increasingly sedentary nature of many forms of recreation activities, changing modes of transportation, and increasing urbanization. With social development and changes in lifestyles, currently children and adolescents are lacking physical activity.[1],[3]

An estimated 315 million people worldwide are obese. Worldwide, prevalence of obesity in Western and developing countries has doubled over the past decade, with 20% of males and 25% of females now classified as obese in the United States and up to double these numbers of the American adult population being overweight.[4]

Studies on obesity among preadolescent and adolescents in India showed a higher prevalence in boys as compared to girls (12.4% vs. 9.9%, 15.7% vs. 12.9%). Prevalence of obesity decreased significantly with age, from 18.5% at 9 years to 7.6% at 14 years, rising at 15 years to 12.1%.[5]

Research suggests that, for the reduction of weight in obese children, various regimes have been tried and have shown beneficial effects in reducing obesity. These include improvement of physical education, extracurricular physical activities, physical activity at home, health education for students and parents, improvement in the diet, and modification in the environment.[2]

Various exercises have been designed for obesity such as aerobic exercises, jogging, rope jumping, endurance running, and basketball are found to be effective. Health education is found to be useful for creating awareness among the children and parents which include increase the consumption of fruit and vegetables, as well as legumes, whole grains, and nuts. The Study also reported reduction of consumption of meat, snacks, western fast food, eating in restaurants, and sugary drinks among children and parents.[6]

Literature suggests that school-based intervention program that includes combination of diet, health education, and moderate to vigorous physical activity results in greater reduction of levels of BMI and skinfold thickness which in turn is helpful in the management of obesity.[2]

There is a paucity of evidence of such school-based intervention in Indian population; hence, there is a need to evaluate the effect of school-based intervention in obese children in our population.


  Methodology Top


Source of data

The present study was conducted in school-going obese children from Love Dale Central School, Belagavi, during September 2016–January 2017.

Study design

This was a randomized controlled trial.

Sample size

δ = dNk/2, where Nk is the harmonic mean of the sample sizes.

Nk = K/Σ(1/ni)

= 2/(1/n1+ 1/n2)

= 2n1n2/n1 + n2)

For our case, with sample size was 29 and 35 cases.

Nk = K/Σ(1/ni)

= 2n1n2/n1 + n2

= 2 × 29 × 35/29 + 35

= 31.78

A total of 32 obese children were recruited in the study and randomly allocated into two groups (A and B) using chit method.

  • Group A: Structured physical Activity (n = 16)
  • Group B: Activity of child's choice (n = 16) [Flow chart 1].



Selection criteria

Inclusion criteria

  1. Male and female obese children between the age of 6 and 12 years
  2. Parents who allow their ward participation in the study.


Exclusion criteria

  1. Children having a history of any cardiovascular and metabolic diseases, asthma, and disabilities
  2. Children involved in any other sports activity or physical activity.


Procedure

The present study is Phase II of the previous study conducted by our institution on the prevalence of obesity in schoolchildren in the month of September 2015. In Phase I, 1165 school children in the age group of 6–12 years were screened for obesity and overweight using outcome measures such as BMI, skinfold measurements, hip circumference, waist circumference, waist–hip ratio, and self-designed questionnaire.

Out of 1165 screened, 33 were found to be obese and 54 were overweight. All the 32 obese children were recruited after obtaining informed assent from the principals of the schools and parents of all the obese children.

The participants were reassessed for obesity using BMI, skinfold measurements, hip circumference, waist circumference, and waist–hip ratio. Then, the participants were randomly allotted into two Groups (A and B) by chit method. Both the groups were given a school-based intervention program for 4 weeks.

The intervention program for Group A included

  • Session on health education, in which a PowerPoint Presentation, was presented for students and parents explaining about risks of obesity, benefits of exercises, healthy diet, and reduced consumption of fast food and carbonated drinks
  • Physical activity of 45 min/day session, 6 days in a week for 4 weeks
  • Physical activities include warm-up exercises for 5 min followed by activities such as rope jumping, sprint for a short distance of 50 m, and jogging in a steady slow speed for 100 m for 10 min each, which was followed by cool down exercises for 6 min [Figure 1].
Figure 1: (a) Rope jumping, (b) sprint running

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The intervention program for Group B included

  • Session on health education, in which a PowerPoint presentation, was presented for students and parents explaining about risks of obesity, benefits of exercises, healthy diet, and reduced consumption of fast food and carbonated drinks
  • Any moderate-to-vigorous physical activity of the child's choice such as running, sprint, jumping, cycling, and shuttle run for duration of 45 min/day session, 6 days in a week for 4 weeks
  • The children in both the groups were reassessed postintervention at 2 weeks and 4 weeks using BMI, skinfold measurement, hip circumference, waist circumference, and hip–waist ratio.



  Results Top


Statistical analysis of the present study was done using Statistical Package for the Social Sciences (SPSS) version 21 (Armonk, NY: IBM Corp) to verify the results obtained. Comparison of pre- and postintervention outcome measures between the two groups was done using independent t-test. P < 0.05 was considered statistically significant and P < 0.001 was considered highly significant.

The mean age of the participants in Group A was 8.81 ± 2.20 years and in Group B was 8.69 ± 2.12 years. On comparing both the groups, there were significant changes in weight, BMI, and skinfold thickness in both the groups. There was no significant change in mean waist–hip ratio in both the groups.

On comparing the mean weight of the two groups, Group A showed 48.31 ± 10.63 reduction in weight and 47.88 ± 9.46 in Group B at the end of 4 weeks. The result between the two groups showed that there is a statistical difference seen between Groups A and B that is Group B shows better results than Group A [Table 1].
Table 1: Weight of participants' preintervention and postintervention in both the groups at 2 and 4 weeks

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On comparing the mean BMI scores of the two groups, Group A showed 29.75 ± 1.12 reduction in BMI and 30.85 ± 1.58 in Group B at the end of 4 weeks. The result between the two groups showed that there is a statistical difference seen between Groups A and B that is Group A shows better results in a reduction in BMI scores than Group B [Table 2].
Table 2: Body mass index of participants' preintervention and postintervention in both the groups at 2 and 4 weeks

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On comparing the mean waist–hip ratio scores of the two groups, Group A showed 0.81 ± 0.07 reduction in waist–hip ratio and 0.81 ± 0.09 in Group B at the end of 4 weeks. The result between the two groups showed that there is no statistical difference seen between Groups A and B [Table 3].
Table 3: Waist–hip ratio of participants' preintervention and postintervention in both the groups at 2 and 4 weeks

Click here to view



  Discussion Top


The present study was conducted to evaluate the effect of the 4-week school-based intervention program in obese children.

As per the literature, the changing dietary practices and sedentary lifestyle have led to an increased prevalence of childhood obesity in the 6–12-year age group children in India. Childhood obesity has increased from 9.8% to 11.7% in India during the year 2006–2009. Therefore, in our study, the age group of 6–12 years was included as childhood obesity is increasing in this age group.[7]

According to the WHO, BMI is one of the best indicators for obesity and is classified as underweight (<18.50), normal range (18.50–24.99), preobese (25–29.99), and obese (>30.00). Obese is further classified as Class I, II, and III.[8]

Physical activity refers to “all leisure and nonleisure body movements resulting in an increased energy output from rest.” Regular physical activity is important for prevention and management of obesity. It also helps in reducing the risk of diseases which are caused due to obesity.[9]

Significant metabolic adaptations occur in skeletal muscle in response to endurance training. There is an increase in both size and number of mitochondria as does the activity of oxidative enzymes. Myoglobin content in the muscle can also be augmented, increasing the amount of oxygen stored in individual muscle fibers, but this effect is variable. Such adaptations, combined with the increase in capillaries and muscle blood flow in the trained muscles, greatly enhance the oxidative capacity of the muscle. Endurance training also increases the capacity of skeletal muscle to store glycogen. The ability of the muscles to use fat as an energy source is also improved, and this greater reliance on fat spares glycogen stores. The increased capacity to use fat following endurance training results from an enhanced ability to mobilize free fatty acids from fat depots and an improved capacity to oxidize fat consequent to the increase in the muscle enzymes responsible for fat oxidation.[10]

The current evidence indicates that moderate intensity (40% to 59% of heart rate reserve) exercise lasting for 45–60 min/day is required to prevent weight gain, and 60–90 min of moderate intensity exercise is required to sustain long-term weight loss.[9]

In our study, moderate (3–6 metabolic equivalents [METs]) to vigorous (>6 METs) physical activity of 45 min/day was given for 4 weeks in addition to health education to children and parents about risks of obesity.

A research done by Li et al. on school-based, multicomponent physical activity intervention was effective in decreasing levels of BMI, skinfold thickness, and fasting sugar. The study was done for a duration of 12 weeks. The multicomponent physical activity intervention for experiment group (n = 388) included physical education, extracurricular physical activities, physical activities at home, and health education lectures for students and parents. Children (n = 533) in the control group participated in usual practice. Physical activities of moderate to vigorous intensity such as basketball, long jumping, rope jumping, and endurance running were given to intervention group for 45 min/week for 12 weeks. The reduction of BMI was statistically significant in the intervention group (adjusted mean difference was 0.43 kg/m 2).[2]

Our study is comparable to Li et al.'s study in terms of multicomponent nature of intervention with physical activity of moderate to vigorous intensity and health education to child and parent of 45 min for 6 days/week for 4 weeks. One group received structured intervention and the other groups received physical activity of child's choice. However, the duration of intervention was less in our study compared to their, which could be the reason for less reduction in mean BMI postintervention (0.66 ± 0.58).

In a study prospectively randomized control trial on obese children, effect of short- and long-term combined dietary-behavioral-physical activity intervention showed a significant increase in leisure time physical activity compared to control group. The study demonstrated both short-and longer-term beneficial effects of a combined dietary-behavioral-physical activity intervention among obese children.[11]

In the present study, a general health education was given, but dietary advice for individual child was not given. Children's food habits were noted in the questionnaire. Few children who had followed healthy food habits showed a better reduction in anthropometric measurements.

In another study on obese children who were given physical activity which included any fitness activities in a 4-week summer camp for 30 min/day reported no significant changes in weight reduction.[12]

However, our study findings are not in accordance to this study, as there was a significant reduction in weight, BMI, and skinfold thickness at the end of 4-week intervention in the group where children were asked to perform activities of their choice indicating that any physical activity of moderate-to-vigorous intensity for 45 min can also help reducing obesity.

A study was done on school-based aerobic exercise program on obesity indices of preschool children. A specially designed exercise program with no diet control included a 15 min walk before beginning the morning class and a 20 min aerobic dance session after the afternoon nap, 3 times a week was conducted for 29.6 weeks. At the end of the study, triceps skinfold thickness cutoff of both the exercise and the control group decreased. The reduction in exercise group decreased from 12.2% at baseline to 8.8%, whereas that of the control group decreased from 11.7% to 9.7%.[13]

In our study, school-based multicomponent intervention was given to obese children for 4 weeks. However, in our study, there was a reduction in skinfold thickness as well as in BMI and weight. The percentage change in triceps thickness was 4.11% and 0.39% in structured and unstructured group, respectively.


  Conclusion Top


Hence, the present study concluded that both the types of school-based physical activity interventions are equally effective in reducing weight, BMI, and skinfold thickness scores. However, structured physical activity showed a better reduction in mean weight (49.30 ± 11.11) at the end of 2 weeks of intervention and nonstructured physical activity showed a better reduction in mean weight (47.88 ± 9.46) at 4 weeks of intervention.

Limitations

  1. Activities could not be carried out for >45 min because of the school timings
  2. Physical activity of life index was not assessed.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Obesity and Overweight. World Health Organization; 2017. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/. [Last accessed on 2017 Mar 09].  Back to cited text no. 1
    
2.
Li XH, Lin S, Guo H, Huang Y, Wu L, Zhang Z, et al. Effectiveness of a school-based physical activity intervention on obesity in school children: A nonrandomized controlled trial. BMC Public Health 2014;14:1282.  Back to cited text no. 2
    
3.
4.
James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res 2001;9 Suppl 4:228S-33S.  Back to cited text no. 4
    
5.
Chhatwal J, Verma M, Riar SK. Obesity among pre-adolescent and adolescents of a developing country (India). Asia Pac J Clin Nutr 2004;13:231-5.  Back to cited text no. 5
    
6.
Doak CM, Visscher TL, Renders CM, Seidell JC. The prevention of overweight and obesity in children and adolescents: A review of interventions and programmes. Obes Rev 2006;7:111-36.  Back to cited text no. 6
    
7.
Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: Epidemiology, determinants, and prevention. Endocr Rev 2012;33:48-70.  Back to cited text no. 7
    
8.
World Health Organization. Global Data Base on Body Mass Index; 2006. Available from: http://www.assessmentpsychology.com/icbmi.htm. [Last accessed on 2017 Mar 10].  Back to cited text no. 8
    
9.
Bouchard C, Katzmarzyk P. Physical Activity and Obesity. Baton Rouge; Louisiana: Human Kinetics; 2000.  Back to cited text no. 9
    
10.
McArdle W, Katch F, Katch V. Practical Exercise Physiology. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.  Back to cited text no. 10
    
11.
Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim A, et al. Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics 2005;115:e443-9.  Back to cited text no. 11
    
12.
Jago R, Baranowski T. Non-curricular approaches for increasing physical activity in youth: A review. Prev Med 2004;39:157-63.  Back to cited text no. 12
    
13.
Mo-suwan L, Pongprapai S, Junjana C, Puetpaiboon A. Effects of a controlled trial of a school-based exercise program on the obesity indexes of preschool children. Am J Clin Nutr 1998;68:1006-11.  Back to cited text no. 13
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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