G. L. Warburton

Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! randomised intervention study

BackgroundThis pragmatic evaluation investigated the effectiveness of the Children’s Health, Activity and Nutrition: Get Educated! (CHANGE!) Project, a cluster randomised intervention to promote healthy weight using an educational focus on physical activity and healthy eating.MethodsParticipants (n = 318, aged 10–11 years) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011. This consisted of a teacher-led curriculum, learning resources, and homework tasks. Primary outcome measures were waist circumference, body mass index (BMI), and BMI z-scores. Secondary outcomes were objectively-assessed physical activity and sedentary time, and food intake. Outcomes were assessed at baseline, at post-intervention (20 weeks), and at follow-up (30 weeks). Data were analysed using 2-level multi-level modelling (levels: school, student) and adjusted for baseline values of the outcomes and potential confounders. Differences in intervention effect by subgroup (sex, weight status, socio-economic status) were explored using statistical interaction.ResultsSignificant between-group effects were observed for waist circumference at post-intervention (β for intervention effect =−1.63 (95% CI = −2.20, -1.07) cm, p<0.001) and for BMI z-score at follow-up (β=−0.24 (95% CI = −0.48, -0.003), p=0.04). At follow-up there was also a significant intervention effect for light intensity physical activity (β=25.97 (95% CI = 8.04, 43.89) min, p=0.01). Interaction analyses revealed that the intervention was most effective for overweight/obese participants (waist circumference: β=−2.82 (95% CI = −4.06, -1.58) cm, p<0.001), girls (BMI: β=−0.39 (95% CI = −0.81, 0.03) kg/m2, p=0.07), and participants with higher family socioeconomic status (breakfast consumption: β=8.82 (95% CI = 6.47, 11.16), p=0.07).ConclusionsThe CHANGE! intervention positively influenced body size outcomes and light physical activity, and most effectively influenced body size outcomes among overweight and obese children and girls. The findings add support for the effectiveness of combined school-based physical activity and nutrition interventions. Additional work is required to test intervention fidelity and the sustained effectiveness of this intervention in the medium and long term.Trial registrationCurrent Controlled Trials ISRCTN03863885.

Using formative research to develop the healthy eating component of the CHANGE! school-based curriculum intervention

BackgroundChildhood obesity is a significant public health concern. Many intervention studies have attempted to combat childhood obesity, often in the absence of formative or preparatory work. This study describes the healthy eating component of the formative phase of the Children’s Health Activity and Nutrition: Get Educated! (CHANGE!) project. The aim of the present study was to gather qualitative focus group and interview data regarding healthy eating particularly in relation to enabling and influencing factors, barriers and knowledge in children and adults (parents and teachers) from schools within the CHANGE! programme to provide population-specific evidence to inform the subsequent intervention design.MethodsSemi-structured focus group interviews were conducted with children, parents and teachers across 11 primary schools in the Wigan borough of North West England. Sixty children (N = 24 boys), 33 parents (N = 4 male) and 10 teachers (N = 4 male) participated in the study. Interview questions were structured around the PRECEDE phases of the PRECEDE-PROCEED model. Interviews were transcribed verbatim and analysed using the pen-profiling technique.ResultsThe pen-profiles revealed that children’s knowledge of healthy eating was generally good, specifically many children were aware that fruit and vegetable consumption was ‘healthy’ (N = 46). Adults’ knowledge was also good, including restricting fatty foods, promoting fruit and vegetable intake, and maintaining a balanced diet. The important role parents play in children’s eating behaviours and food intake was evident. The emerging themes relating to barriers to healthy eating showed that external drivers such as advertising, the preferred sensory experience of “unhealthy” foods, and food being used as a reward may play a role in preventing healthy eating.ConclusionsData suggest that; knowledge related to diet composition was not a barrier per se to healthy eating, and education showing how to translate knowledge into behavior or action is required. The key themes that emerged through the focus groups and pen-profiling data analysis technique will be used to inform and tailor the healthy eating component of the CHANGE! intervention study.Trial registrationCurrent Controlled Trials ISRCTN03863885

BMI status of children in the CHANGE! Project and its association with the consumption of ‘positive marker’ and ‘negative marker’ foods

G. L. Warburton, E. Mahon, I. G. Davies, R. Gobbi, K. Mackintosh, S. J. Fairclough and J. C. Abayomi Faculty of Education, Community and Leisure, Liverpool John Moores University, Liverpool, UK, Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK, Faculty of Science and Social Science, Liverpool Hope University, Liverpool, UK and Applied Sports Technology Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK

Macronutrient intake and relations to physical activity and sedentary behaviour in 10–11 year old children: The CHANGE! Project

Prolonged sedentary (SED) behaviour, and low levels of physical activity (PA), are independently and positively associated with all-cause mortality and risk of chronic diseases such as obesity, cancer, cardiovascular disease (CVD) and type 2 diabetes mellitus. Furthermore, a high energy intake and increased consumption of dietary fat, carbohydrates and sugars increases risk of obesity, and associated chronic disease, including CVD and cancer The combination of these unhealthy behaviours therefore increases overall risk for these diseases. The aims of this cross sectional study were to assess the relationships of PA, and SED, with total energy and macronutrient intake in 10 to 11 year old children. Participants (n = 55) were recruited from 11 primary schools from a North West English town, of those 40 provided complete data sets for all measures (mean age = 10.6, SD = 0.28 years). Habitual PA was measured using 7 day accelerometry, cut points were >2160 counts per minute for moderate to vigorous intensity PA (MVPA) and<100 CPM for sedentary time (SED). Children completed a 7 day food diary and food diaries were input into Microdiet to estimate mean daily total energy intake (KCal) and the following macronutrients, as a percentage of total energy; protein, carbohydrate (CHO), starch and sugars, fat, mono unsaturated fatty acids (MUFA), poly unsaturated fatty acids (PUFA), and saturated fatty acids (SFA). Pearson’s correlation coefficients, controlling for gender and somatic maturation, were completed to assess the relationships between total energy, macronutrients and MVPA and SED and total PA (average CPM). SED had moderate positive correlations with total energy intake (kcal) (r = 0.610, p<0.001) and %PUFA (% of total KCal) (r = 0.582, p<0.001). SED also had weak negative correlations with %CHO (% of total Kcal) (r = 0.381, p = 0.018) and %Starch (% of total Kcal) (r = 0.429, p = 0.007). Total PA (average CPM) had a moderate negative correlation with total energy (kcals) (r = 0.455, p = 0.004). MVPA was not significantly correlated with total energy intake or any of the macronutrients (p>0.05). In conclusion, correlations exist between SED and total energy intake and PUFA. Furthermore total PA and total energy are correlated. The combination of these unhealthy behaviours needs addressing since it is known that clustering of unhealthy behaviours increase overall risk of chronic disease. Furthermore behaviour established in childhood is likely to track into adulthood, further increasing risk later in life. Further investigation is warranted.

Comparison of the reported intakes of fruits and vegetables in Year 6 children: The CHANGE! Project

. The CHANGE! Project(ChildrenOs Health, Activity, and Nutrition: Get Educated!), involving Year 6 children ( n = 290 total; n = 138 intervention; n = 152control) in Wigan, aimed to promote the consumption of FV as part of a healthy lifestyle. A teaching resource was adapted and Anglicisedfrom the Planet Health programme

The impact of a 17 km recreational walk on measures of body composition and hydration in a group of walkers aged >40 years

1.71 0.70 1.06 0.43 - 0.64 0.62 - 0.27, - 1.02 Reaction test (s) 0.26 0.13 0.26 0.09 0.003 0.14 0.09, - 0.08 Fluid available (kg) 1.10 0.53 0.28 0.37 - 0.81 0.52 - 0.50, - 1.13 BP, blood pressure; PCV, packed cell volume.