Randomised controlled trial of primary school based intervention to reduce risk factors for obesity

doi:10.1136/bmj.323.7320.1029

BMJ 2001;323:1029 ( 3 November )

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Randomised controlled trial of primary school based intervention to reduce risk factors for obesity

Editorial by Atkinson

Pinki Sahota, senior lecturer in nutrition and dietetics, ^a Mary C J Rudolf, consultant community paediatrician, ^b Rachael Dixey, principal lecturer in health promotion, ^a Andrew J Hill, senior lecturer in behavioural sciences, ^c Julian H Barth, consultant in chemical pathology and metabolic medicine, ^d Janet Cade, senior lecturer in nutritional epidemiology. ^e

^a School of Health Sciences, Leeds Metropolitan University, Leeds LS1 3HE, ^b Leeds Community and Mental Health Trust, Belmont House, Leeds LS2 9DE, ^c School of Medicine, Leeds University, Leeds LS2 9LT, ^d Leeds General Infirmary, Leeds LS1 3EX, ^e Nuffield Institute of Health, Leeds LS2 9PL

Correspondence to: M C J Rudolf Mary.Rudolf{at}leedsth.nhs.uk

Objective: To assess if a school based intervention waseffective in reducing risk factors forobesity.
Design: Group randomised controlledtrial.
Setting: 10 primary schools inLeeds.
Participants: 634 children aged 7-11years.
Intervention: Teacher training, modification of school meals,and the development of school action plans targeting the curriculum,physical education, tuck shops, and playgroundactivities.
Main outcome measures: Body mass index, diet, physical activity,and psychologicalstate.
Results: Vegetable consumption by 24 hour recall washigher in children in the intervention group than the controlgroup (weighted mean difference 0.3 portions/day, 95% confidenceinterval 0.2 to 0.4), representing a difference equivalent to50% of baseline consumption. Fruit consumption was lower in obesechildren in the intervention group ( $-$ 1.0, $-$ 1.8 to $-$ 0.2) than thosein the control group. The three day diary showed higher consumptionof high sugar foods (0.8, 0.1 to 1.6)) among overweight childrenin the intervention group than the control group. Sedentary behaviourwas higher in overweight children in the intervention group (0.3,0.0 to 0.7). Global self worth was higher in obese children inthe intervention group (0.3, 0.3 to 0.6). There was no differencein body mass index, other psychological measures, or dieting behaviourbetween the groups. Focus groups indicated higher levels of selfreported behaviour change, understanding, and knowledge amongchildren who had received theintervention.
Conclusion: Although it was successful in producing changesat school level, the programme had little effect on children'sbehaviour other than a modest increase in consumption ofvegetables.

What is already known on this topic
Obesity is increasing among school children and demands preventive strategies

Randomised controlled trials of school based primary prevention programmes have all used a prescriptive approach

What this study adds
Behavioural changes were disappointing with this programme based on the health promoting schools philosophy, despite changes at school level

The only positive outcome was a modest increase in vegetable consumption

The discrepancy between changes achieved at the individual and school level raises issues regarding the problems inherent in such trials

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