Effect of an Educational Intervention on Healthy Lifestyle in Iranian Children and Adolescents: The Iran-Ending Childhood Obesity (IRAN-ECHO) Program
-
Zahra Abdollahi
,
Ali-Akbar Sayyari
,
Beheshteh Olang
,
Hassan Ziaodini
,
Hossein Fallah
,
Zahra Abasalti
,
Fereshteh Fozouni
,
Sakineh Jafari
,
Farhad Lashkarlouki
,
Mahnoush Sahebdel
,
Arash Siadati
,
Hamideh Aslani
,
Roya Riahi
,
Motahar Heidari-Beni
,
Roya Kelishadi
Abstract
Background: This study aimed at examining the effect of an educational program on children’s and adolescents’ knowledge of, attitude toward, and practice of healthy lifestyle habits.
Methods: This was a quasi-experimental nationwide intervention carried out as part of the Iran-Ending Childhood Obesity (IRAN-ECHO) program. Participants were selected from six cities of Iran. The sample size was calculated to be 1264 for each city. Knowledge of, attitude toward, and practice of healthy nutritional habits were measured at baseline and following the intervention. A physician and a dietitian provided recommendations on healthy diet, screen time, physical activity, and sleep time. Behavioral therapy was given when necessary.
Results: The prevalence of overweight or obesity was 7.6%. The frequency of students with desirable knowledge was significantly greater after the intervention compared with baseline (32.5% vs 24.8%, p = 0.02). The mean score for attitude toward obesity complications significantly increased from 73.09 to 74.78 (p = 0.03). There was also a significant increase in the mean score for the practice of low consumption of unhealthy snacks after the intervention (difference = 1.63, p = 0.03). The mean score for participation in mild physical activity increased from 50.67 to 65 after the intervention (p < 0.001). However, there were no significant changes in the number of students with desirable attitude and practice following the intervention (p> 0.05).
Conclusion: The study shows that an educational intervention based on WHO-ECHO recommendations can be useful for improving the knowledge of a healthy lifestyle in children and adolescents. Over time, it might lead to a positive attitude and behavior toward a healthier lifestyle. Continued professional education and implementation of guidelines for the prevention and management of early childhood overweight and obesity are suggested.
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2. Ali MF, Dasari H, Van Keulen VP, Cornec D, Vasmatzis G, Peikert T, et al. Microbial Antigens Stimulate Metalloprotease-7 Secretion in Human B-Lymphocytes Using mTOR-Dependent and Independent Pathways. Sci Rep. 2017;7(1):3869.
3. Skinner AC, Perrin EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999-2014. Obesity. 2016;24(5):1116-23.
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6. Djalalinia S, Kelishadi R, Qorbani M, Peykari N, Kasaeian A, Nasli-Esfahani E, et al. A Systematic Review on the Prevalence of Overweight and Obesity, in Iranian Children and Adolescents. Iran J Pediatr. 2016;26(3):e2599.
7. Baygi F, Dorosty AR, Kelishadi R, Qorbani M, Asayesh H, Mansourian M, et al. Determinants of childhood obesity in representative sample of children in north East of iran. Cholesterol. 2012;2012:875163.
8. Wilkie HJ, Standage M, Gillison FB, Cumming SP, Katzmarzyk PT. Multiple lifestyle behaviours and overweight and obesity among children aged 9-11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment. BMJ Open. 2016;6(2):e010677.
9. Smetanina N, Albaviciute E, Babinska V, Karinauskiene L, Albertsson-Wikland K, Petrauskiene A, et al. Prevalence of overweight/obesity in relation to dietary habits and lifestyle among 7–17 years old children and adolescents in Lithuania. BMC Public Health. 2015;15:1001.
10. Cureau FV, Sparrenberger K, Bloch KV, Ekelund U, Schaan BD. Associations of multiple unhealthy lifestyle behaviors with overweight/obesity and abdominal obesity among Brazilian adolescents: A country-wide survey. Nutr Metab Cardiovasc Dis. 2018;28(7):765-774.
11. Hills AP, Dengel DR, Lubans DR. Supporting Public Health Priorities: Recommendations for Physical Education and Physical Activity Promotion in Schools. Prog Cardiovasc Dis. 2015;57(4):368-74.
12. Mei H, Xiong Y, Xie S, Guo S, Li Y, Guo B, et al. The impact of long-term school-based physical activity interventions on body mass index of primary school children - a meta-analysis of randomized controlled trials. BMC Public Health. 2016; 16:205.
13. Silveira JA, Taddei JA, Guerra PH, Nobre MR. The effect of participation in school-based nutrition education interventions on body mass index: a meta-analysis of randomized controlled community trials. Prev Med. 2013;56(3-4):237-43.
14. Chen Y, Ma L, Ma Y, Wang H, Luo J, Zhang X, et al. A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China. BMC Public Health. 2015; 15:210.
15. Aperman-Itzhak T, Yom-Tov A, Vered Z, Waysberg R, Livne I, Eilat-Adar S. School-Based Intervention to Promote a Healthy Lifestyle and Obesity Prevention Among Fifth- and Sixth-Grade Children. Am J Heal Educ. 2018; 49(5):289–95.
16. Francis M, Nichols SS, Dalrymple N. The effects of a school-based intervention programme on dietary intakes and physical activity among primary-school children in Trinidad and Tobago. Public Health Nutr. 2010;13(5):738-47.
17. Zenzen W, Kridli S. Integrative review of school-based childhood obesity prevention programs. J Pediatr Health Care. 2009;23(4):242-58.
18. Heo M, Jimenez CC, Lim J, Isasi CR, Blank AE, Lounsbury DW, et al. Effective nationwide school-based participatory extramural program on adolescent body mass index, health knowledge and behaviors. BMC Pediatr. 2018;18(1):7.
19. American Dietetic Association (ADA). Position of the American Dietetic Association: individual-, family-, school-, and community-based interventions for pediatric overweight. J Am Diet Assoc. 2006;106(6):925-45.
20. Commission on Ending Childhood Obesity. Report of the Commission on Ending Childhood Obesity. Geneva: World Health Organization. 2016;
21. Sayyari AA, Abdollahi Z, Ziaodini H, Olang B, Fallah H, Salehi F, et al. Methodology of the Comprehensive Program on Prevention and Control of Overweight and Obesity in Iranian Children and Adolescents: The IRAN‑Ending Childhood Obesity (IRAN‑ECHO) Program. Int J Prev Med. 2017;8:107.
22. Gies I, Al Saleem B, Olang B, Karima B, Samy G, Husain K, et al. Early childhood obesity: A survey of knowledge and practices of physicians from the Middle East and North Africa. BMC Pediatr. 2017;17(1):115.
23. Lakshman RR, Sharp SJ, Ong KK, Forouhi NG. A novel school-based intervention to improve nutrition knowledge in children : cluster randomised controlled trial. BMC Public Health. 2010;10:123.
24. Li M, Li S, Baur LA, Huxley RR. A systematic review of school-based intervention studies for the prevention or reduction of excess weight among Chinese children and adolescents. Obes Rev. 2008;9(6):548-59.
25. Corkins MR, Daniels SR, de Ferranti SD, Golden NH, Kim JH, Magge SN, Schwarzenberg SJ. Nutrition in Children and Adolescents. Med Clin North Am. 2016; 100(6):1217-1235.
26. Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev. 2017; 6(6):CD012651.
27. Demir Acar M, Bayat M. The Effect of Diet-Exercise Trainings Provided to Overweight and Obese Teenagers through Creative Drama on Their Knowledge, Attitude, and Behaviors. Child Obes. 2019;15(2):93-104.
28. Wright K, Giger JN, Norris K, Suro Z. Impact of a nurse-directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: A parallel-group, randomized control trial. Int J Nurs Stud. 2013;50(6):727-37.
29. McKenzie TL, Nader PR, Strikmiller PK, Yang M, Stone EJ, Perry CL, et al. School Physical Education: Effect of the Child and Adolescent Trial for Cardiovascular Health. Prev Med. 1996;25(4):423-31.
30. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB. Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. J Pediatr. 1996;128(6):797-805.
31. Chen Y, Ma L, Ma Y, Wang H, Luo J, Zhang X, et al. A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China. BMC Public Health. 2015; 15:210.
32. Stock S, Miranda C, Evans S, Plessis S, Ridley J, Yeh S, et al. Healthy Buddies: A Novel, Peer-Led Health Promotion Program for the Prevention of Obesity and Eating Disorders in Children in Elementary School. Pediatrics. 2007;120(4):e1059-68.
33. Cason KL, Logan BN. Educational Intervention Improves 4th-Grade Schoolchildrenʼs Nutrition and Physical Activity Knowledge and Behaviors. Top Clin Nutr. 2006; 21(3):234–40.
34. Prelip M, Slusser W, Thai CL, Kinsler J, Erausquin JT. Effects of a School-Based Nutrition Program Diffused Throughout a Large Urban Community on Attitudes, Beliefs, and Behaviors Related to Fruit and Vegetable Consumption. J Sch Health. 2011;81(9):520-9.
35. Koo HC, Poh BK, Ruzita AT. Intervention on whole grain with healthy balanced diet to manage childhood obesity (GReat-ChildTM trial): study protocol for a quasi-experimental trial. Springerplus. 2016;5(1):840.
36. Sharif Ishak SI, Chin YS, Mohd Taib MN, Mohd Shariff Z. School-based intervention to prevent overweight and disordered eating in secondary school Malaysian adolescents: a study protocol. BMC Public Health. 2016;16(1):1101.
37. Marcus C, Nordenfelt A, Nyberg G, Karpmyr M, Kowalski J. STOPP; Stockholm Obesity Prevention Programme: effect of a 4 year school-based randomised prevention study on overweight prevalence among children 6-10 years of age | Request PDF. [cited 2019 Feb 12]; Available from: https://www.researchgate.net/publication/296100868_STOPP_Stockholm_Obesity_Prevention_Programme_effect_of_a_4_year_school-based_randomised_prevention_study_on_overweight_prevalence_among_children_6-10_years_of_age
38. Austin SB, Kim J, Wiecha J, Troped PJ, Feldman HA, Peterson KE. School-Based Overweight Preventive Intervention Lowers Incidence of Disordered Weight-Control Behaviors in Early Adolescent Girls. Arch Pediatr Adolesc Med. 2007;161(9):865-9.
39. James J, Thomas P, Kerr D. Preventing childhood obesity: Two year follow-up results from the Christchurch obesity prevention programme in schools (CHOPPS). BMJ. 2007;335(7623):762.
40. Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V. School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med. 2009;37(5):418-27.
41. Guerra PH, da Silveira JA, Salvador EP. Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews. J Pediatr (Rio J). 2016;92(1):15-23.
42. Hung LS, Tidwell DK, Hall ME, Lee ML, Briley CA, Hunt BP. A meta-analysis of school-based obesity prevention programs demonstrates limited efficacy of decreasing childhood obesity. Nutr Res. 2015;35(3):229-40.
2. Ali MF, Dasari H, Van Keulen VP, Cornec D, Vasmatzis G, Peikert T, et al. Microbial Antigens Stimulate Metalloprotease-7 Secretion in Human B-Lymphocytes Using mTOR-Dependent and Independent Pathways. Sci Rep. 2017;7(1):3869.
3. Skinner AC, Perrin EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999-2014. Obesity. 2016;24(5):1116-23.
4. Fruh SM. Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. J Am Assoc Nurse Pract. 2017;29:S3-S14.
5. Kumar S, Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin Proc. 2017;92(2):251-265.
6. Djalalinia S, Kelishadi R, Qorbani M, Peykari N, Kasaeian A, Nasli-Esfahani E, et al. A Systematic Review on the Prevalence of Overweight and Obesity, in Iranian Children and Adolescents. Iran J Pediatr. 2016;26(3):e2599.
7. Baygi F, Dorosty AR, Kelishadi R, Qorbani M, Asayesh H, Mansourian M, et al. Determinants of childhood obesity in representative sample of children in north East of iran. Cholesterol. 2012;2012:875163.
8. Wilkie HJ, Standage M, Gillison FB, Cumming SP, Katzmarzyk PT. Multiple lifestyle behaviours and overweight and obesity among children aged 9-11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment. BMJ Open. 2016;6(2):e010677.
9. Smetanina N, Albaviciute E, Babinska V, Karinauskiene L, Albertsson-Wikland K, Petrauskiene A, et al. Prevalence of overweight/obesity in relation to dietary habits and lifestyle among 7–17 years old children and adolescents in Lithuania. BMC Public Health. 2015;15:1001.
10. Cureau FV, Sparrenberger K, Bloch KV, Ekelund U, Schaan BD. Associations of multiple unhealthy lifestyle behaviors with overweight/obesity and abdominal obesity among Brazilian adolescents: A country-wide survey. Nutr Metab Cardiovasc Dis. 2018;28(7):765-774.
11. Hills AP, Dengel DR, Lubans DR. Supporting Public Health Priorities: Recommendations for Physical Education and Physical Activity Promotion in Schools. Prog Cardiovasc Dis. 2015;57(4):368-74.
12. Mei H, Xiong Y, Xie S, Guo S, Li Y, Guo B, et al. The impact of long-term school-based physical activity interventions on body mass index of primary school children - a meta-analysis of randomized controlled trials. BMC Public Health. 2016; 16:205.
13. Silveira JA, Taddei JA, Guerra PH, Nobre MR. The effect of participation in school-based nutrition education interventions on body mass index: a meta-analysis of randomized controlled community trials. Prev Med. 2013;56(3-4):237-43.
14. Chen Y, Ma L, Ma Y, Wang H, Luo J, Zhang X, et al. A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China. BMC Public Health. 2015; 15:210.
15. Aperman-Itzhak T, Yom-Tov A, Vered Z, Waysberg R, Livne I, Eilat-Adar S. School-Based Intervention to Promote a Healthy Lifestyle and Obesity Prevention Among Fifth- and Sixth-Grade Children. Am J Heal Educ. 2018; 49(5):289–95.
16. Francis M, Nichols SS, Dalrymple N. The effects of a school-based intervention programme on dietary intakes and physical activity among primary-school children in Trinidad and Tobago. Public Health Nutr. 2010;13(5):738-47.
17. Zenzen W, Kridli S. Integrative review of school-based childhood obesity prevention programs. J Pediatr Health Care. 2009;23(4):242-58.
18. Heo M, Jimenez CC, Lim J, Isasi CR, Blank AE, Lounsbury DW, et al. Effective nationwide school-based participatory extramural program on adolescent body mass index, health knowledge and behaviors. BMC Pediatr. 2018;18(1):7.
19. American Dietetic Association (ADA). Position of the American Dietetic Association: individual-, family-, school-, and community-based interventions for pediatric overweight. J Am Diet Assoc. 2006;106(6):925-45.
20. Commission on Ending Childhood Obesity. Report of the Commission on Ending Childhood Obesity. Geneva: World Health Organization. 2016;
21. Sayyari AA, Abdollahi Z, Ziaodini H, Olang B, Fallah H, Salehi F, et al. Methodology of the Comprehensive Program on Prevention and Control of Overweight and Obesity in Iranian Children and Adolescents: The IRAN‑Ending Childhood Obesity (IRAN‑ECHO) Program. Int J Prev Med. 2017;8:107.
22. Gies I, Al Saleem B, Olang B, Karima B, Samy G, Husain K, et al. Early childhood obesity: A survey of knowledge and practices of physicians from the Middle East and North Africa. BMC Pediatr. 2017;17(1):115.
23. Lakshman RR, Sharp SJ, Ong KK, Forouhi NG. A novel school-based intervention to improve nutrition knowledge in children : cluster randomised controlled trial. BMC Public Health. 2010;10:123.
24. Li M, Li S, Baur LA, Huxley RR. A systematic review of school-based intervention studies for the prevention or reduction of excess weight among Chinese children and adolescents. Obes Rev. 2008;9(6):548-59.
25. Corkins MR, Daniels SR, de Ferranti SD, Golden NH, Kim JH, Magge SN, Schwarzenberg SJ. Nutrition in Children and Adolescents. Med Clin North Am. 2016; 100(6):1217-1235.
26. Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev. 2017; 6(6):CD012651.
27. Demir Acar M, Bayat M. The Effect of Diet-Exercise Trainings Provided to Overweight and Obese Teenagers through Creative Drama on Their Knowledge, Attitude, and Behaviors. Child Obes. 2019;15(2):93-104.
28. Wright K, Giger JN, Norris K, Suro Z. Impact of a nurse-directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: A parallel-group, randomized control trial. Int J Nurs Stud. 2013;50(6):727-37.
29. McKenzie TL, Nader PR, Strikmiller PK, Yang M, Stone EJ, Perry CL, et al. School Physical Education: Effect of the Child and Adolescent Trial for Cardiovascular Health. Prev Med. 1996;25(4):423-31.
30. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB. Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. J Pediatr. 1996;128(6):797-805.
31. Chen Y, Ma L, Ma Y, Wang H, Luo J, Zhang X, et al. A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China. BMC Public Health. 2015; 15:210.
32. Stock S, Miranda C, Evans S, Plessis S, Ridley J, Yeh S, et al. Healthy Buddies: A Novel, Peer-Led Health Promotion Program for the Prevention of Obesity and Eating Disorders in Children in Elementary School. Pediatrics. 2007;120(4):e1059-68.
33. Cason KL, Logan BN. Educational Intervention Improves 4th-Grade Schoolchildrenʼs Nutrition and Physical Activity Knowledge and Behaviors. Top Clin Nutr. 2006; 21(3):234–40.
34. Prelip M, Slusser W, Thai CL, Kinsler J, Erausquin JT. Effects of a School-Based Nutrition Program Diffused Throughout a Large Urban Community on Attitudes, Beliefs, and Behaviors Related to Fruit and Vegetable Consumption. J Sch Health. 2011;81(9):520-9.
35. Koo HC, Poh BK, Ruzita AT. Intervention on whole grain with healthy balanced diet to manage childhood obesity (GReat-ChildTM trial): study protocol for a quasi-experimental trial. Springerplus. 2016;5(1):840.
36. Sharif Ishak SI, Chin YS, Mohd Taib MN, Mohd Shariff Z. School-based intervention to prevent overweight and disordered eating in secondary school Malaysian adolescents: a study protocol. BMC Public Health. 2016;16(1):1101.
37. Marcus C, Nordenfelt A, Nyberg G, Karpmyr M, Kowalski J. STOPP; Stockholm Obesity Prevention Programme: effect of a 4 year school-based randomised prevention study on overweight prevalence among children 6-10 years of age | Request PDF. [cited 2019 Feb 12]; Available from: https://www.researchgate.net/publication/296100868_STOPP_Stockholm_Obesity_Prevention_Programme_effect_of_a_4_year_school-based_randomised_prevention_study_on_overweight_prevalence_among_children_6-10_years_of_age
38. Austin SB, Kim J, Wiecha J, Troped PJ, Feldman HA, Peterson KE. School-Based Overweight Preventive Intervention Lowers Incidence of Disordered Weight-Control Behaviors in Early Adolescent Girls. Arch Pediatr Adolesc Med. 2007;161(9):865-9.
39. James J, Thomas P, Kerr D. Preventing childhood obesity: Two year follow-up results from the Christchurch obesity prevention programme in schools (CHOPPS). BMJ. 2007;335(7623):762.
40. Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V. School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med. 2009;37(5):418-27.
41. Guerra PH, da Silveira JA, Salvador EP. Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews. J Pediatr (Rio J). 2016;92(1):15-23.
42. Hung LS, Tidwell DK, Hall ME, Lee ML, Briley CA, Hunt BP. A meta-analysis of school-based obesity prevention programs demonstrates limited efficacy of decreasing childhood obesity. Nutr Res. 2015;35(3):229-40.
| Files | ||
| Issue | Vol 5, No 1/2 (Winter/Spring 2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jnsd.v5i1.5234 | |
| Keywords | ||
| Health behavior Education knowledge Nutrition; Iran Attitude | ||
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How to Cite
1.
Abdollahi Z, Sayyari A-A, Olang B, Ziaodini H, Fallah H, Abasalti Z, Fozouni F, Jafari S, Lashkarlouki F, Sahebdel M, Siadati A, Aslani H, Riahi R, Heidari-Beni M, Kelishadi R. Effect of an Educational Intervention on Healthy Lifestyle in Iranian Children and Adolescents: The Iran-Ending Childhood Obesity (IRAN-ECHO) Program. J Nutr Sci & Diet. 2019;5(1-2):32-39.
