Effect of School-Based Interventions on Body Mass Index Among Adolescents: A Systematic Review and Meta-Analysis

Gomathi Munusamy; Ramesh Shanmugam

doi:10.55489/njcm.130920222266

Authors

Gomathi Munusamy Centre of Postgraduate Studies, Faculty of Nursing, Lincoln University College, Petaling Jaya, Selangor, Malaysia
Ramesh Shanmugam Centre of Postgraduate Studies, Faculty of Nursing, Lincoln University College, Petaling Jaya, Selangor, Malaysia; School of Nursing, Institute of Health Sciences, Bule Hora University, Bule Hora, Ethiopia https://orcid.org/0000-0001-5676-9351

DOI:

https://doi.org/10.55489/njcm.130920222266

Keywords:

Adolescent, Body mass index, Diet, Physical activity, Schools, Sedentary behavior

Abstract

Background: High body mass index is a common well-known issue among adolescents, its related morbid-ity track to adulthood life and decrease life expectancy. The review aims to derive a consensus on school-based intervention on body mass index. Objective: This review evaluates the effect of school-based inter-ventions in reducing or preventing high body mass index for adolescents.

Method: A literature search was performed in six electronic databases: Pubmed, Science Direct index, Sci-Hub, HINARI, and Google Scholar to identify published studies between January 2010 and December 2020. Only randomized controlled studies evaluated the effect of physical activity and/or physical education and nutritional education and/or dietary behavior, sedentary behavior outcome reporting on body mass index among adolescents were included. The Standard Cochrane tool was used to assess the risk of bias for indi-vidual studies. An evaluation of the effects of included interventions on body mass index was done using a random effects model.

Results: There were 6 trials included. 2503 adolescent partakers met the inclusion criteria. Meta-analysis showed there is a significant difference between length of intervention between 3 to 12 months were MD -0.44 kg [95% CI: 1.06, 0.18], p-value = 0.04, with evidence of substantial study between heterogeneity (I2 = 61%).

Discussion: Intervention less than three to twelve months more effective with multiple school-based inter-ventions among adolescents. Numerous studies are needed for evaluation to determine long-term interven-tion effectiveness targeted on adolescents.

References

WHO. Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity: Report of the Ad hoc Working Group on Science and Evidence for Ending Childhood Obesity. World Heal Organ. 2016;1-219.

Nadeau KJ, Maahs DM, Daniels SR, Eckel RH. Childhood obesity and cardiovascular disease: links and prevention strategies. Nat Rev Cardiol [Internet]. 2011 Sep 14;8(9):513-25. Available from: http://www.nature.com/articles/nrcardio.2011.86. Doi: https://doi.org/10.1038/nrcardio.2011.86 PMid:21670745 PMCid:PMC4292916

Heshmat R, Qorbani M, Shahr Babaki AE, Djalalinia S, Ataei-Jafari A, Motlagh ME, et al. Joint association of screen time and physical activity with cardiometabolic risk factors in a national sample of Iranian adolescents: The CASPIANIII study. PLoS One [Internet]. 2016;11(5):1-15. Doi: https://doi.org/10.1371/journal.pone.0154502 PMid:27167372 PMCid:PMC4864273

Kumar S, Ray S, Roy D, Ganguly K, Dutta S, Mahapatra T, et al. Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India. BMC Public Health [Internet]. 2017 Dec 18;17(1):468. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4390-9 Doi: https://doi.org/10.1186/s12889-017-4390-9 PMid:28521735 PMCid:PMC5437535

Odunaiya NA, Louw QA, Grimmer KA. Are lifestyle cardiovascular disease risk factors associated with pre-hypertension in 15-18 years rural Nigerian youth? A cross sectional study. BMC Cardiovasc Disord [Internet]. 2015;15(1):1-10. Doi: https://doi.org/10.1186/s12872-015-0134-x PMid:26537355 PMCid:PMC4632346

Kinra S, Johnson M, Kulkarni B, Rameshwar Sarma K V., Ben-Shlomo Y, Smith GD. Socio-economic position and cardiovascular risk in rural indian adolescents: Evidence from the Andhra Pradesh children and parents study (APCAPS). Public Health [Internet]. 2014;128(9):852-9. Doi: https://doi.org/10.1016/j.puhe.2014.06.005 PMid:25220689 PMCid:PMC4211329

Taylor SA, Borzutzky C, Jasik CB, Mihalopoulos NL, Smith-Barron K, Woolford SJ, et al. Preventing and treating adolescent obesity: a position paper of the society for adolescent health and medicine. J Adolesc Heal. 2016;59(5):602-6. Doi: https://doi.org/10.1016/j.jadohealth.2016.08.020 PMid:27772662 PMCid:PMC5147420

World Health Organization. Global status report on noncommunicable diseases [Internet]. World Health Organization. 2014 [cited 2021 May 21]. p. 1-280. Available from: https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf;jsessionid=9F1E3370174E079EBE7902C898240D20?sequence=186458_eng.pdf

World Health Organization. Physical activity for health: more active people for a healthier world [Internet]. Vol. 45, World. 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/272722/9789241514187-eng.pdf

Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Stu. Lancet [Internet]. 2018 Nov;392(10159):1923-94. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673618322256

WHO. WHO Guidelines on physical activity and sedentary behaviour [Internet]. Routledge Handbook of Youth Sport. 2016. 1-582 p. Available from: https://apps.who.int/iris/bitstream/handle/10665/337001/9789240014886-eng.pdf/Accessed 11 July 2022

Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895-905. Doi: https://doi.org/10.1007/s00125-012-2677-z PMid:22890825

Katula JA, Kirk JK, Pedley CF, Savoca MR, Effoe VS, Bell RA, et al. The Lifestyle Intervention for the Treatment of Diabetes Study (LIFT Diabetes): design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors. Contemperorary Clin trial. 2017;53:88-99. Doi: https://doi.org/10.1016/j.cct.2016.12.005 PMid:27940180 PMCid:PMC5274593

Martinez-Gomez D, Rey-Lopez JP, Chillon P, Gómez-Martínez S, Vicente-Rodriguez G, Martín-Matillas M, et al. Excessive TV viewing and cardiovascular disease risk factors in adolescents. the AVENA cross-sectional study. BMC Public Health. 2010;10:1-8. Doi: https://doi.org/10.1186/1471-2458-10-274 PMid:20500845 PMCid:PMC2892447

Rathi N, Riddell L, Worsley A. Food consumption patterns of adolescents aged 14-16 years in Kolkata, India. Nutr J [Internet]. 2017 Aug 24;16(1):50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28836982 Doi: https://doi.org/10.1186/s12937-017-0272-3 PMid:28836982 PMCid:PMC5571590

Kelly S, Stephens J, Hoying J, McGovern C, Melnyk BM, Militello L. A systematic review of mediators of physical activity, nutrition, and screen time in adolescents: implications for future research and clinical practice. Nurs Outlook. 2017;65(5):530-48. Doi: https://doi.org/10.1016/j.outlook.2017.07.011 PMid:28823500 PMCid:PMC7164544

Hynynen S-T, van Stralen MM, Sniehotta FF, Araújo-Soares V, Hardeman W, Chinapaw MJM, et al. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents. Int Rev Sport Exerc Psychol [Internet]. 2016 Jan 22;9(1):22-44. Available from: http://www.tandfonline.com/doi/full/10.1080/1750984X.2015.1081706. Doi: https://doi.org/10.1080/1750984X.2015.1081706 PMid:26807143 PMCid:PMC4706019

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34. Doi: https://doi.org/10.1016/j.jclinepi.2009.06.006 PMid:19631507

Higgins JPT, Altman DG, Gotzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343(7829):1-9. Doi: https://doi.org/10.1136/bmj.d5928 PMid:22008217 PMCid:PMC3196245

Crowther MA, Lim W. Systematic review and meta-analysis methodology. Blood [Internet]. 2010;116(17):3140-6. Doi: https://doi.org/10.1182/blood-2010-05-280883 PMid:20656933

Leme ACB, Baranowski T, Thompson D, Nicklas T, Philippi ST. Sustained impact of the "Healthy Habits, Healthy Girls - Brazil" school-based randomized controlled trial for adolescents living in low-income communities. Prev Med Reports. 2018;10(April):346-52. Doi: https://doi.org/10.1016/j.pmedr.2018.04.013 PMid:29868390 PMCid:PMC5984243

Lubans DR, Smith JJ, Plotnikoff RC, Dally KA, Okely AD, Salmon J, et al. Assessing the sustained impact of a school-based obesity prevention program for adolescent boys: the ATLAS cluster randomized controlled trial. Int J Behav Nutr Phys Act [Internet]. 2016;13(1):1-12. Doi: https://doi.org/10.1186/s12966-016-0420-8 PMid:27542825 PMCid:PMC4992277

Grydeland M, Bjelland M, Anderssen SA, Klepp KI, Bergh IH, Andersen LF, et al. Effects of a 20-month cluster randomised controlled school-based intervention trial on BMI of school-aged boys and girls: the HEIA study. Br J Sports Med. 2014;48(9):768-73. Doi: https://doi.org/10.1136/bjsports-2013-092284 PMid:23624466 PMCid:PMC3995249

Dewar DL, Morgan PJ, Plotnikoff RC, Okely AD, Collins CE, Batterham M, et al. The nutrition and enjoyable activity for teen girls study: A cluster randomized controlled trial. Am J Prev Med. 2013;45(3):313-7. Doi: https://doi.org/10.1016/j.amepre.2013.04.014 PMid:23953358

Lori Pbert, Druker S, Gapinski MA, Gellar L, Magner R, Reed G, et al. A school nurse-delivered intervention for overweight and obese adolescents. J Sch Health. 2013;83(3):182-93. Doi: https://doi.org/10.1111/josh.12014 PMid:23343319 PMCid:PMC3556993

Pbert L, Druker S, Barton B, Schneider KL, Olendzki B, Gapinski MA, et al. A school-based program for overweight and obese adolescents: a randomized controlled trial. J Sch Health. 2016;86(10):699-708. Doi: https://doi.org/10.1111/josh.12428 PMid:27619760 PMCid:PMC5033122

Friedrich RR, Schuch I, Wagner MB. Effect of interventions on the body mass index of school-age students. Rev Saude Publica. 2012;46(3):551-60. Doi: https://doi.org/10.1590/S0034-89102012005000036 https://doi.org/10.1590/S0034-89102012000300018 PMid:22527193

Kornet-van der Aa DA, Altenburg TM, van Randeraad-van der Zee CH, Chinapaw MJM. The effectiveness and promising strategies of obesity prevention and treatment programmes among adolescents from disadvantaged backgrounds: a systematic review. Obes Rev. 2017;18(5):581-93. Doi: https://doi.org/10.1111/obr.12519 PMid:28273680

Palmer M, Sutherland J, Barnard S, Wynne A, Rezel E, Doel A, et al. The effectiveness of smoking cessation, physical activity/diet and alcohol reduction interventions delivered by mobile phones for the prevention of non-communicable diseases: a systematic review of randomised controlled trials. Vol. 13, PLoS ONE. 2018. 1-71 p. Doi: https://doi.org/10.1371/journal.pone.0189801 PMid:29304148 PMCid:PMC5755775

Safron M, Cislak A, Gaspar T, Luszczynska A. Effects of school-based interventions targeting obesity-related behaviors and body weight change: a systematic umbrella review. Behav Med. 2011;37(1):15-25. Doi: https://doi.org/10.1080/08964289.2010.543194 PMid:21347906

Al-Khudairy L, Loveman E, Colquitt JL, Mead E, Johnson RE, Fraser H, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev. 2017;2017(6). Doi: https://doi.org/10.1002/14651858.CD012691 PMid:28639320

United Nations. Transforming our world: the 2030 agenda for sustainable development [Internet]. 2019. Available from: https://sustainabledevelopment.un.org/content/documents/21252030 Agenda for Sustainable Development web.pdf/Accessed 23 August 2019.