Introduction
Obesity is the most common eating disorder in children in developed countries. Heredity, environment, lifestyle, and dietary habits play a crucial role in the development of obesity. Therefore, the school needs to form a model of behavior among schoolchildren that prevents the development of obesity. The purpose of this paper is to find out the impact of participation in behavioral modification classes on weight and daily activity in obese high school students compared to no lessons over the course of four years of high school.
Description of Search for Literature
The PICO(T) question is formulated as follows: “In high-school aged children who are obese (P) who participate in behavioral modification classes(I) compared to no classes (C), does it affect weight and daily activity (O) over 4 years of high school (T)?”
The search terms “obesity”, “high school students”, and “prevention” were used in Google Scholar to find studies demonstrating the effect of preventive measures for the disease in schools. The limiters used are the date of writing – the article should have been written within 5 years. The inclusive dates were from January 1, 2018, to September 17, 2023.
In addition, systematic reviews or meta-analyses from the found list were excluded. Moreover, articles written in English were selected, since some of the information could be distorted when translated from other languages. The topics were exclusively medical articles: those related to other sciences, such as sociology, were excluded. Thus, the initial search returned 21 articles. When the search was narrowed further to reduce the number of articles, there were 6of them.
Synthesis of Obesity Prevention
Liu et al. (2022) employed a cluster-randomized clinical trial design. In this case, the study design resembled a randomized clinical trial with parallel groups. However, it was not individuals who were randomized into the study groups, but clusters of high school students. Hayes et al. conducted qualitative, semi-structured interviews with participants using a multiple-case study design (2019). In both Hayes et al. (2019) and Lung et al. (2020), a standard categorization grid was used to code the data from the interviews that were conducted. The RE-AIM implementation framework’s Adoption, Implementation, and Maintenance components were used for the thematic analysis.
Maglie et al. (2022) and Ma et al. (2019) used a control group intervention. In schools that have never participated in health promotion programs, the effect of introducing physical activity into the curriculum was studied in practice. It was introduced into a control group that studied at one of the schools with a similar socio-economic status to the students. Habib et al. (2020) and Liu et al. (2022) employed a randomized clinical trial design. The test participants were randomly assigned to control groups, making this study design similar to that used in Maglie et al. (2022). Therefore, in three of the four studies, randomization is necessary for distributing test participants into control groups.
In Liu et al.’s (2022) study, 1392 eligible students between the ages of 8 and 10 who attended 24 schools were randomly assigned (1:1) to either the intervention group or the control group. From October 1 to December 31, 2019, data from the intent-to-treat population were examined (Liu et al., 2022). According to Hayes et al. (2019), qualified schools have to meet the following criteria. Schools can be found throughout the counties of Dublin, Wicklow, and Kildare, which are a combination of urban and rural areas. 552 Food Dudes intervention and 364 Green Schools Travel intervention schools were eligible. Four from each program were included in the initial sample of eight schools, which was deemed sufficient to achieve data saturation and practical given the study’s time and financial constraints.
In Maglie et al. (2022), the children in the intervention group (n = 80) took part in a multifaceted PA that improved after-school physical activity (with an additional 40 minutes per day for 5 or 6 days per week)—the 80 kids who made up the control group engaged in routine activities. In terms of body mass index, participants had a mean of 19.7 2.9 kg/m2, and 33.7% of them were obese or overweight at T0. Unlike previous studies, this one selected a sample not from whole classes, but from individual students. Samples in Ma et al. (2019) and Lung et al. (2020) included not only schoolchildren but also adults aged 18 and above.
In Habib-Mourad et al. (2020), randomization was used to assign 36 public and private schools to either an intervention or control group. Anthropometric measures and questionnaires regarding the students’ eating and exercise habits were filled out before and after the exam. The program elements were given to the intervention group students over the course of two years.
Thus, in all studies, except Maglie et al. (2022), schools were selected as a sample. However, Hayes et al. (2019) noted that schools with similar socio-economic statuses of students participated. In contrast, Liu et al. (2022) and Habib-Murad et al. (2020) included schools with varying student demographics and backgrounds.
In Liu et al. (2022), a multimodal intervention was found to be effective in decreasing body mass index compared to the control group in a cluster-randomized clinical trial involving 1392 children from 24 primary schools. Compared to the control group, which saw a 6% reduction in obesity prevalence, the intervention group saw a 27% increase (Liu et al., 2022). In Hayes et al. (2019), it was concluded that public health anti-obesity programs in schools must be well-integrated within their environments, supported by multiple levels of leadership, have stable funding, and be successfully implemented and scaled up. Some suggestions for removing obstacles include the capacity to deliver within a curriculum that is already overloaded and the explicit characterization of intervention components within a conceptual framework, which enables evaluation. Thus, this study focused on identifying details that would enable healthcare programs implemented in schools to become successful.
In Maglie et al. (2022), when comparing the intervention group to the control group, noticeable changes were also observed in waist circumference, waist-to-height ratio, and physical fitness (all p < 0.05). Additionally, there is a substantial drop in the proportion of overweight or obese children in the experimental group, which was estimated as 17.5% (Maglie et al., 2022). Therefore, these results implied that a school-based intervention program is an efficient means of reducing the proportion of overweight and obese children.
In Habib-Mourad et al. (2020), only in public schools did students in the intervention groups have lower washout rates of obesity. In intervention groups, more kids reported changing their eating habits than ever before, but only public schools had a long-lasting impact. Lung et al. (2020) stated that to achieve permanent behavior changes and modify eating habits in children, nutrition programs and regulations aimed at creating a healthy nutritional environment in schools must be implemented.
The type of research design – randomized clinical trial with control groups was used in almost all studies except Hayes et al. (2019). All the studies used different types of samples: schools were located in various countries (Ireland, Australia, China, and the USA), had participants of different ages, and had students with varying financial statuses. However, one theme that emerged from the literature is the consistent type of findings.
Without exception, all four papers indicate that the healthcare program was beneficial. Liu et al. (2022) and Magic et al. (2022) provide specific statistical data indicating weight improvements observed in children. Hayes et al. (2019) argue that a program can yield excellent results if certain conditions are met. Habib-Mouradi et al. (2020) also indicate that the introduction of healthcare programs can reduce the number of obese children, but make a reservation that this method is more successful in public schools. Lung et al. (2020) and Ma et al. (2019) conclude that healthcare programs help prevent not only obesity but also other comorbid diseases, such as depression.
Gaps in the Literature
A topic that was not reviewed in the literature is the impact of healthcare programs on schools with a dominant African American or Latin ethnicity of students. These children have a specific national diet, which may influence their weight and predisposition to obesity. In all the selected papers, general schools were studied, without considering the ethnic background of the students. Therefore, a narrower study that takes into account national minorities may help close the gap in the literature concerning school obesity prevention.
Conclusion
Thus, an important thing is the need to implement healthcare programs in high school. Studies show that obesity is a rather complex health problem that is better prevented than treated. Healthcare programs have demonstrated their effectiveness in various schools and for different students, leading us to conclude that, compared to not participating in any courses, enrolling in behavioral modification programs in high school had a positive impact on weight and daily activity in these teenagers.
References
Habib-Mourad, C., Ghandour, L. A., Maliha, C., Dagher, M., Kharroubi, S., & Hwalla, N (2020). Impact of a three-year obesity prevention study on healthy behaviors and BMI among lebanese schoolchildren: Findings from AjyalSalima program. Nutrients, 12(2687), 1-14.
Hayes, C. B., O’Shea, M. P., Foley-Nolan, C., McCarthy, M., & Harrington, J. M. (2019). Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren: A DEDIPAC case study. BMC Public Health, 19(198), 68-80.
Liu, Z., Gao, P., & Gao, A. Y. (2022). Effectiveness of a multifaceted intervention for prevention of obesity in primary school children in China: A cluster randomized clinical trial. JAMA Pediatrics, 176(1), e214375.
Lung, T., Baur, L. A., Bauman, A., & Hayes, A. (2020). Can reducing childhood obesity solve the obesity crisis in Australia?Obesity, 28(5), 857-859.
Ma, J., Rosas, L. G., Lv, N., Xiao, L., Snowden, M. B., Venditti, E. M., Lewis, M. A., Goldhaber-Fiebert, J. D., & Lavori, P. W. (2019). Effect of integrated behavioral weight loss treatment and problem-solving therapy on body mass index and depressive symptoms among patients with obesity and depression. The Journal of the American Medical Association, 321(9), 869-879.
Maglie, A. D., Marsigliante, S., My, G., Colazzo, S., & Muscella, A. (2022). Effects of a physical activity intervention on schoolchildren fitness. Physiological Report, 10(e15115), 1-13.