Effect of educational intervention on healthy lifestyle in Iranian children and adolescents: The IRAN-Ending Childhood Obesity (IRAN-ECHO) Program

educational intervention on healthy lifestyle

  • 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 Mail Assistant Professor, Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
  • Roya Kelishadi
Keywords:
Health behavior, Education, knowledge, attitude

Abstract

Background: Overweight and obesity during childhood and adolescence are increasing as public health problem

Objective: This study aimed at examining the effect of the education program on children and adolescents’ knowledge, attitudes and behavior in relation to healthy lifestyle.

Methods: This study was performed as a quasi-experimental national survey as part of the IRAN-Ending Childhood Obesity (IRAN-ECHO) program. Participants were selected from six cities of Iran. The sample size was calculated as 1264 for each city. Nutrition-related knowledge, attitudes and behavior were measured at pre- and post-intervention surveys. Physician and dietitian provided recommendations on healthy dietary, reducing screen time, increasing physical activity, and sufficient sleep time, as well as behavioral therapy when necessary.

Results: The prevalence of excess weight (overweight/obesity) was 7.6%. The frequency of desirable knowledge after intervention (32.5%) is significantly higher than before intervention (24.8%) (p-value=0.02). The mean score of attitude about obesity complications was significantly increased from 73.09 to 74.78 after intervention (p-value < 0.05). There was significant increase in mean score of practice in relation to low consumption of unhealthy snacks after intervention compared to the baseline (difference = 1.63, p-value=0.03). The mean score of mild physical activity increased from 50.67 to 65 after intervention (p-value< 0.001). There was no significant differences between the desirable total attitude and total practice before and after the intervention (p-value > 0.05).

Conclusion: Educational intervention based on WHO-ECHO recommendations can be useful for improvement the knowledge related to healthy lifestyle in children and adolescents; over time it might lead to change in attitude and in turn in improving their practice

References

1. Güngör NK. Overweight and obesity in children and adolescents. J Clin Res Pediatr Endocrinol. 2014 Sep;6(3):129–43.
2. Lobstein T, Baur L. obesity reviews 4 Obesity in children and young people: a crisis in public health. 2004.
3. 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. 2016;26(3):2599.
4. 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.
5. 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 Feb 24;6(2):e010677.
6. 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 Dec 1;15(1):1001.
7. 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 Jul 1;28(7):765–74.
8. Hills AP, Dengel DR, Lubans DR. Supporting Public Health Priorities: Recommendations for Physical Education and Physical Activity Promotion in Schools. Prog Cardiovasc Dis. 2015 Jan;57(4):368–74.
9. 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 Mar 1;16:205.
10. Silveira JAC da, Taddei JA de AC, Guerra PH, Nobre MRC. The effect of participation in school-based nutrition education interventions on body mass index: A meta-analysis of randomized controlled community trials. Prev Med (Baltim). 2013;56(3–4):237–43.
11. Chen Y, Ma L, Ma Y, Wang HH, 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. 2015;1–10.
12. 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.
13. Francis M, Nichols SSD, 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.
14. Zenzen W, Kridli S. Integrative Review Prevention Childhood Obesity of School-based Programs. J Adv Res Dyn Control Syst. 2018;10(12 Special Issue):1–7.
15. 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):1–10.
16. 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 Jun;106(6):925–45.
17. Commission on Ending Childhood Obesity. Report of the Commission on Ending Childhood Obesity. Geneva: World Health Organization. 2016;
18. Sayyari A, 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.
19. 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):1–7.
20. Lakshman RR, Sharp SJ, Ong KK, Forouhi NG. A novel school-based intervention to improve nutrition knowledge in children : cluster randomised controlled trial. 2010;1–9.
21. 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. 2008;2000(5):548–59.
22. Corkins MR, Daniels SR, de Ferranti SD, Golden NH, Kim JH, Magge SN, et al. Nutrition in Children and Adolescents. Med Clin North Am. 2016 Nov;100(6):1217–35.
23. 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 Jun 22;6:CD012651.
24. 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. 2018;X(X):chi.2018.0046.
25. 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.
26. 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 (Baltim). 1996 Jul;25(4):423–31.
27. 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 Jun;128(6):797–805.
28. 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. 2015;1–10.
29. 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 Oct 1;120(4):e1059–68.
30. Cason KL, Logan BN. Educational Intervention Improves 4th-Grade Schoolchildrenʼs Nutrition and Physical Activity Knowledge and Behaviors. Top Clin Nutr. 2006 Jul 1;21(3):234–40.
31. 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 Sep;81(9):520–9.
32. Koo HC, Poh BK, Ruzita AT. Intervention on whole grain with healthy balanced diet to manage childhood obesity (GReat-ChildTMtrial): study protocol for a quasi-experimental trial. Springerplus. 2016;5(1).
33. Sharif Ishak SIZ, 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):1–12.
34. 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.
35. 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 Sep 1;161(9):865.
36. James J, Thomas P, Kerr D. Preventing childhood obesity: Two year follow-up results from the Christchurch obesity prevention programme in schools (CHOPPS). Br Med J. 2007;335(7623):762–4.
37. 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.
38. Guerra PH, Da Silveira JAC, 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.
39. 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.
Published
2019-12-27
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 educational intervention on healthy lifestyle in Iranian children and adolescents: The IRAN-Ending Childhood Obesity (IRAN-ECHO) Program. J Nutr Sci & Diet. 5(1).
Section
Original Article(s)