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Child Obesity - School-Based Programs
Obesity Among Children and Adolescents at School
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Child Obesity - School-Based Programs

Childhood Obesity & Primary School Programs
Most obesity interventions have taken place in clinical settings, however schools provide an excellent opportunity for preventing and treating obesity.

School-based approaches for childhood obesity can be separated into either primary or secondary interventions. Primary interventions focus on prevention of obesity and adopt the population approach or target high-risk individuals at risk of developing obesity. Secondary interventions target those with existing obesity.

Childhood Obesity & Secondary School Programs
Secondary intervention school-based programs targeted at obese children and adolescents have been attempted mainly in the US since the mid 1960s and have met with some success. Programs reporting positive results included particularly those aimed at younger children; those which combined both diet and exercise and those with parental involvement. Although interventions aimed at obese children consistently report positive effects, these studies have methodological and ethical problems which limit their internal validity and generalisability. Most participants are parentally volunteered, most interventions multi-componented, not evaluated and there is limited follow-up post intervention. It is also felt that isolating children on the basis of their weight may further compound any psychosocial problems they may already experience.

Childhood Obesity & Primary School Intervention Program
An alternative strategy is to implement a primary intervention program which is targeted at all pupils or at pupils who are at a high risk of becoming overweight. These initiatives have also met with some success, although outcome assessed in terms of change in weight or body fat is generally not as robust when compared to the studies targeted solely at obese pupils. Many of these studies have examined the entire pupil cohort using anthropometric measurements with inherent error, rather than considering the effect of the program on children within separate weight categories.

Childhood Obesity Risk of Adult Obesity
However, this population-based approach in the prevention of obesity is desirable and likely to be more effective than approaches targeted at fat children because the prediction for adult obesity from child measures is poor. Therefore population-based approaches have the potential to reduce children's risk of adult obesity.

APPLES Program Tackling Childhood Obesity
Two key components for obesity prevention are diet and physical activity. Within schools both should be promoted as part of a co-ordinated, comprehensive program for school health.

The APPLES Program was designed as a multi-agency, multidisciplinary program using a population approach underpinned by the Health Promoting Schools philosophy. The program was successfully implemented and produced changes at school level, however it had little effect on children's behaviour other than a modest increase in vegetable consumption. It is suggested that this approach shows potential for school-based obesity prevention programs.

Source: Dr Pinki Sahota, School of Health Sciences, Leeds Metropolitan University, Leeds, UK.

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