1. Growing Pains: A Systematic Review of Childhood Obesity
Interventions
Sa’sha Moody, Health Education and Promotion Student [B.S.P.H.], Georgia Southern University
Introduction
Purpose
Methods
Discussion/Recommendations
References
Results
According to the Center of Disease Control and Prevention
(2014), childhood obesity is one of the major public health issues
today. Not only does food intake and physical activity play a major
part in this epidemic, but it can stem from other aspects as well, such
as emotional problems. The past three decades have seen a
dramatic global increase in childhood/adolescent obesity (Jelalian,
2007). This has made obesity a huge issue for public health due to
the effects it places on children once they grow older and also the
effect it has on life expectancy (Daniels, 2006).
.
Because school is one of the places that children spend
majority of their day, it fits with the implementation of healthy
behaviors and can be used as the basis of health promotion
interventions (Sharma, 2007). Not only should interventions take
place in the school setting, but they should also take place in the
family setting as well. Families play an important role in a child’s
development and life experiences, so the prevention of obesity in
young children will require effective approaches for working with
families (Davison, Jurkowski, Li, Kranz, & Lawson, 2013). Although
working with families is important, this review will focus on school-
based interventions. The purpose of this review is to examine school-
based interventions done to reduce childhood obesity.
Data Sources
Most of the articles reviewed were found using Galileo, which is a
scholarly search engine that allows the researcher to search through
databases related to their terms and topics. The articles were found in
the following databases: Medline with Full Text, Child Development
and Adolescent Studies, Education Full Text, ERIC, and PsycInfo. The
terms searched for were childhood, obesity, interventions, theory, and
school-based. This provided 44 articles to choose from. Google
Scholar, a search engine made by Google for finding scholarly articles
was used also. The terms searched for using Google Scholar were
childhood, obesity, intervention, and theory. This provided 70,000
articles, but only two of those articles was selected and used for this
review.
Study Selection
Only full text and scholarly/peer reviewed journals in English
were used. The articles reviewed in this study were published during
the time frame of 1999 and 2014. Research studies that did not include
interventions based on theory or interventions taking place in a school
setting were excluded from this review.
In total the researcher looked at 45 articles to determine whether they would meet the
inclusion and exclusion criteria. Of the articles reviewed, the researcher found 5 articles that
met the criteria included in this review. Articles were excluded because they did not focus on
school-based intervention, did not use theory, or were a review of interventions previously
done. An overview of these articles can be seen in table 1.
Two of the articles used Social Cognitive Theory and Behavioral Choice Theory to
implement their interventions. Gortmaker, S. (1999) discovered that obesity rates were lower
among females after the Planet Health sessions, which shows that the intervention is a good
approach to reducing obesity among youth. The other intervention that used social cognitive
theory and behavioral choice theory was also effective. It showed that there were decreases in
the percentages of total energy from fat and saturated fat. Dietary intake was improved and
television watching was reduced. The social marketing approach was applied in the early
stages of this intervention.
Hawley S, Beckman H, Bishop T. (2006) used self – efficacy and Stages of Change
Theory with their intervention. There was not a significant change among the students, as there
was for the families. A longer intervention period might have had a better effect on the families,
which could have pushed more of a change among the students.
Ahmed A, Oshiro C, Loharuka S, Novotny R (2011) used a grounded theory approach
with the gardening program intervention that was in place at the school in Hawai’i. The study
showed that school gardening programs exemplify healthy eating, providing healthy food and
teaching youth how to grow their own food at home.
Lloyd J, Logan S, Greaves C, Wyatt K. (2011) implemented the Healthy Lifestyles
Program which used the Intervention Mapping Protocol. Although the younger children seemed
to be more receptive to the program than the older children, this intervention proved to be
acceptable in being used in school to promote healthy living among youth.
Study Participants Measurement Theory/Experiment Used Intervention Results
Hawley S, Beckman H,
Bishop T.(2006)
65 sixth grade students and
25 of the students families
A cohort, repeated measures design. Five
40 minute sessions during PE classes over
a course of six weeks. Self- reported
physical activity by assigning metabolic
equivalent scores (METs) to each activity
and self-reported eating behaviors
measured by calculating total calories and
fat grams
for the foods consumed by students and
family members over the past 24 hours.
Questionnaires, Pre-tests and Post-tests
were also used.
Self – Efficacy and Stages of Change
delivery of a five-session middle
school classroom program over a 6-
week period and implementation of a
community
event (a Family Fun Night) to
promote physical activity and
nutrition.
The study indicated that the student sample might
have been more advanced than expected in their
understanding of the importance of good nutrition and
fitness therefore the intervention did not cause a
significant change among them from pre-intervention
to post-intervention as it did for the families.
Ahmed A, Oshiro C, Loharuka S, Novotny R(2011) 9 educators at a Hawai’i Island Middle School (2
administrators, 4 teachers, and 3 garden staff)
Semi-structured interviews of the 9 middle school educators
at a school with a garden program in rural Hawai‘i were
conducted.
Qualitative analysis of data was based upon a grounded theory
approach using descriptive, open coding
Gardening Program implemented in the school Perceived benefits of school-based gardening included
improving children’s diet, engaging children in physical
activity, creating a link to local tradition, mitigating hunger,
and improving social skills.
Poverty was cited as a barrier to adoption of healthy eating
habits.
Lloyd J, Logan S, Greaves C, Wyatt K. (2011) In pilot one 119 Children aged 8-11, parents and
teachers from a primary school and in pilot two 77
children aged 9-10
semi structured interviews
(teachers and parents), focus groups (children), questionnaire
responses (parents), documentation of
parental and child involvement and observations of
intervention delivery
Intervention Mapping protocol which uses behavioral theory and research
evidence; concepts from the Social Cognitive Theory
Healthy Lifestyles Program (HeLP), a school-based
intervention to prevent obesity in children
Two phases of pilot work demonstrated that the intervention
was acceptable and feasible for schools,
children and their families and suggested areas for further
refinement. Younger children were more receptive to the
behavior changes than the older children.
Gortmaker, S. (1999). A group of 1295 ethnically diverse grade 6 and 7
students from public schools in Massachusetts
communities
Randomized controlled field trial with 5 interventions and 5
control schools
Social Cognitive Theory and Behavioral Choice Theory School-based interdisciplinary intervention over 2 school years.
Planet Health Sessions were included within existing curricula.
Sessions focused on decreasing television viewing, decreasing
consumption of high fat foods, increasing fruit and vegetable
intake, and increasing physical activity.
Planet Health decreased obesity among female students
indicating a good approach for reducing obesity among
youth.
Gortmaker, S., Cheung, L., Peterson, K., Chomitz, G.,
Cradle, J., Dart, H., ... Laird, N. (1999).
479 students initially in grade 4 in Baltimore, Md,
public schools; 91% were African American. Repeated
24-hour recall measures in 1997 were collected for a
random subsample of 336 students. Cross-sectional
survey data were collected from all grade 5 students in
1995, 1996, and 1997 (n=2103).
quasiexperimental field trial with 6 intervention and 8 matched
control schools. Outcomes were assessed longitudinally using
preintervention (fall 1995) and follow-up (spring 1997) student
survey food frequency and activity measures and follow-up 24-
hour recall measures of diet and activity. Change was also
assessed using yearly repeated cross-sectional surveys of all grade
5 students from 1995 through 1997.
Social Marketing Approach, Behavioral choice theory, and social cognitive
theory
The Eat Well and Keep Moving Program was taught by classroom
teachers over 2 years in math, science, language arts, and social
studies classes. Materials provided links to school food services
and families and provided training and wellness programs for
teachers and other staff members. Intervention materials focused
on decreasing consumption of foods high in total and saturated fat
and increasing fruit and vegetable intake, as well as reducing
television viewing and increasing physical activity.
The 24-hour recall measures indicated that, after controlling
for baseline covariates, the percentages of total energy from
fat and saturated fat were reduced among students in the
intervention compared with control schools. There was an
increase in fruit and vegetable intake, in vitamin C intake,
and in fiber consumption. Television viewing was
marginally reduced. Evaluation of the Eat Well and Keep
Moving Program indicates effectiveness in improving
dietary intake of students and reducing television viewing.
Table 1. School-based Interventions Targeting Childhood Obesity
Staniford, L. J., Breckon, J. D., & Copeland, R. J. (2012). Treatment of childhood obesity: A systematic review.
Journal Of Child And Family Studies, 21(4), 545-564.
Daniels, S. R. (2006). The consequences of childhood overweight and obesity. The future of children, 16(1),
47-67.
Centis, E. E., Marzocchi, R. R., Di Luzio, R. R., Moscatiello, S. S., Salardi, S. S., Villanova, N. N., & Marchesini,
G. G. (2012). A controlled, class‐based multicomponent intervention to promote healthy lifestyle and to reduce
the burden of childhood obesity. Pediatric Obesity, 7(6), 436-445.
Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A childhood obesity intervention
developed by families for families: Results from a pilot study. The International Journal Of Behavioral Nutrition
And Physical Activity, 10
Hawley S, Beckman H, Bishop T. Development of an Obesity Prevention and Management Program for
Children and Adolescents in a Rural Setting. Journal Of Community Health Nursing [serial online].
2006;23(2):69-80. Available from: PsycINFO, Ipswich, MA. Accessed October 27, 2014.
Tucker S, Lanningham-Foster L, Lohse C, et al. A School Based Community Partnership for Promoting Healthy
Habits for Life. Journal Of Community Health [serial online]. June 2011;36(3):414-422. Available from:
Education Full Text (H.W. Wilson), Ipswich, MA. Accessed October 27, 2014.
Ahmed A, Oshiro C, Loharuka S, Novotny R. Perceptions of middle school educators in Hawai'i about school-
based gardening and child health. Hawaii Medical Journal [serial online]. July 2011;70(7 Suppl 1):11-15.
Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 27, 2014.
Lloyd J, Logan S, Greaves C, Wyatt K. Evidence, theory and context—Using intervention mapping to develop a
school-based intervention to prevent obesity in children. The International Journal Of Behavioral Nutrition And
Physical Activity [serial online]. July 13, 2011;8Available from: PsycINFO, Ipswich, MA. Accessed October 27,
2014.
Gortmaker, S. (1999). Reducing Obesity via a School-Based Interdisciplinary Intervention Among YouthPlanet
Health. Archives of Pediatrics & Adolescent Medicine, 409-409. Retrieved November 18, 2014, from
http://archpedi.jamanetwork.com/article.aspx?articleid=346206
Gortmaker, S., Cheung, L., Peterson, K., Chomitz, G., Cradle, J., Dart, H., ... Laird, N. (1999). Impact of a
School-Based Interdisciplinary Intervention on Diet and Physical Activity Among Urban Primary School
Children. Archives of Pediatrics & Adolescent Medicine, 975-975. Retrieved November 18, 2014, from
http://archpedi.jamanetwork.com/article.aspx?articleid=347688
Centers for Disease Control and Prevention (2014). Childhood Obesity Facts Retrieved November 19, 2014, from
http://www.cdc.gov/healthyyouth/obesity/facts.htm
Cutting short lunch time in school may lead to obesity. (n.d.). Retrieved November 19, 2014, from
The articles that proved to have the most successful interventions out of
all of the articles reviewed used Social Cognitive Theory. These interventions
also were worked into the teachers’ curricula which proved to be effective
because the teachers’ could make the information personal. The study of
Lloyd J, Logan S, Greaves C, and Wyatt K was also a successful intervention
that used some concepts from the Social Cognitive Theory and the Intervention
Mapping Protocol. This study also included involving teachers and parents
which proved to be effective. The study done by Ahmed A, Oshiro C, Loharuka
S, and Novotny R showed that gardening programs are successful in teaching
children about nutrition, but the effects of this type of intervention on obesity
needs to be further examined. The least successful intervention did not see
much of a change among the students, because they seemed to already
understand the importance of good nutrition and physical activity.
Although many interventions have been done to combat childhood
obesity, school-based interventions have proven to be effective in reducing
obesity among youth. The CDC (2014) has stated that schools play a
particularly critical role by establishing a safe and supportive environment with
policies and practices that support healthy behaviors and they also provide
opportunities for students to learn about and practice healthy eating and
physical activity behaviors. Applying the Social Cognitive Theory to school-
based interventions should be done to ensure that the intervention s will be a
success with the participants by taking into account their environment,
situation,expectations, self-efficacy and self-control. By taking all aspects of
one’s lifestyle into consideration and creating a program that addresses each
aspect, many changes can be made to improve unhealthy behaviors.