Susanne Kobel

Intervention effects of a school-based health promotion programme on obesity related behavioural outcomes.

Studies have shown preventive effects of an active lifestyle during childhood on later life; therefore, health promotion has to start early. The programme “Join the Healthy Boat” promotes a healthy lifestyle in primary school children. In order to evaluate it, childrens behaviours in respect of increased physical activity (PA), a decrease in screen media use (SMU), more regular breakfast, and a reduction of the consumption of soft drinks (SDC) were investigated. 1943 children (7.1 ± 0.6 years) participated in the cluster-randomised study and were assessed at baseline and 1736 of them at follow-up. Teachers delivered lessons, which included behavioural contracting and budgeting of SMU and SDC. Daily SMU, PA behaviours, SDC, and breakfast patterns were assessed via parental questionnaire. After one-year intervention, significant effects were found in the intervention group for SMU of girls, children without migration background, and children with parents having a low education level. In the control group, second grade children skipped breakfast significantly more often. Tendencies but no significant differences were found for PA and SDC. This intervention seems to affect groups, which are usually hard to reach, such as children of parents with low education levels, which shows that active parental involvement is vital for successful interventions.

Is central obesity associated with poorer health and health-related quality of life in primary school children? Cross-sectional results from the Baden-Württemberg Study

BackgroundChildhood obesity and its consequences are a growing threat to national economies and health services. The aim of this study was to determine associations between waist-to-height ratio (WHtR) as a measure of central obesity, and health-related quality of life (HRQoL) and absenteeism of primary school children in the state of Baden-Württemberg, Germany.MethodsCross-sectional data from 1888 first and second grade children (7.1±0.6 years) participating in the baseline measurements of the Baden-Württemberg Study were analyzed. Parents completed questionnaires including a rating of their children’s HRQoL using KINDLR and EQ5D-Y VAS. Days of absence because of illness, and number of visits to a physician during the last year of school/kindergarten were asked, as well as the number of days parents took off work to care for their sick child. Anthropometric measurements were taken by trained staff. The Mann-Whitney-U test was used for statistical analysis of differences between WHtR groups. Logistic regression models were used to identify factors associated with sick days.ResultsA total of 158 (8.4%) children were centrally obese (WHtR ≥0.5). These children had significantly more sick days (9.05 vs. 6.84, p < 0.001) and visits to a physician (3.58 vs. 2.91, p < 0.05), but not days of parental absence than other children. According to regression analysis, sick days were also associated with age, migration status, physical activity pattern, maternal health awareness and family education level. Parent-rated HRQoL was significantly lower in centrally obese children for the EQ5D-Y VAS (88.1 vs. 91.6, p < 0.001), and the KINDLR subscales ’school’ (79.9 vs. 82.5, p < 0.05) and ’friends’ (75.4 vs. 78.3, p < 0.05), but not for the total score.ConclusionsCross-sectional results show higher rates of absence, more visits to a physician and lower HRQoL in children with central obesity. Each missed day at school implies a hazard to academic achievement and each additional visit to a physician is related to higher health care costs. Thus, the negative impact of central obesity is already measurable in primary school children, which emphasizes the urgent need for early delivery of health promotion and targeted prevention.

Interaction of sedentary behaviour, sports participation and fitness with weight status in elementary school children

Abstract Even though the effect of single components contributing to weight gain in children have been addressed only limited research is available on the combined association of sports participation, physical fitness and time spent watching TV with body weight in children. Baseline data from 1594 children (809 male; 785 female), 7.1±0.6 years of age participating in a large school-based intervention in southern Germany was used. Height and weight was measured and body mass index (BMI) percentiles (BMIPCT) were determined accordingly. Sports participation and time spent watching TV was assessed via parent questionnaire while fitness was determined via a composite fitness test. Combined and single associations of sports participation, TV time and fitness with BMIPCT and weight status were assessed via ANCOVA as well as logistic regression analysis, controlling for age and sex. A significant interaction of TV time, sports participation and fitness on BMIPCT occurred, despite low correlations among the three components. Further, there was a combined association of sports participation and TV time on BMIPCT. TV time and fitness were also independently associated with BMIPCT. Similarly, only increased TV time and lower fitness were associated with a higher odds ratio for overweight/obesity. These results underline the complex interaction of TV time, sports participation and fitness with BMIPCT. In children, TV time and fitness have a stronger influence on BMIPCT compared to sports participation. Sports participation, however, may not reflect overall activity levels of children appropriately. More research is necessary to examine the complex interaction of various behaviours and fitness with BMIPCT.

Does a Higher Incidence of Break Times in Primary Schools Result in Children Being More Physically Active

BACKGROUND Regular physical activity (PA) has multiple benefits to health; however, the majority of schoolchildren do not reach PA guidelines of 60 minutes of moderate to vigorous PA (MVPA) daily. During the school day, break times are often the only opportunity for children to be physically active. This study investigated PA levels during school breaks in German primary school children. METHODS PA of 294 children (7.1 ± 0.7 years; 48% boys) was assessed. On the basis of timetables, individual activity times and intensities for daily breaks were determined. Childrens weight status was determined on site. RESULTS Breaks lasted 30.7 (± 13.8) minutes; length varied significantly between 1 and 2 breaks (21.7 ± 4.1 versus 36.2 ± 14.8 minutes; p ≤ .01). Children spent 25.3% of their breaks in MVPA, boys being significantly more active (30.8% versus 20.4%; p ≤ .01). Time spent in MVPA differed significantly between normal weight and overweight/obese children (26.1% versus 18.4%; p ≤ .05). Children having 2 breaks engaged in significantly more MVPA than those with only 1 (7.4 ± 6.1 versus 5.6 ± 4.7 minutes; p ≤ .02). CONCLUSIONS Children spent 25% of their break in MVPA; having 2 breaks increased time in MVPA significantly, although this is also influenced by weight status. Consequently, more activity breaks should be scheduled during school hours.

Correlates of weight gain in German children attending elementary school

OBJECTIVE To examine the association of physical fitness, sports participation, physical activity and sedentary behavior as well as dietary patterns and family background with weight gain in non-overweight elementary school children, independent of absolute body weight. METHODS Height, weight, and physical fitness were assessed in 1249 (51% male) children in south-west Germany during the fall of 2010 and 2011 (age at baseline: 7.0±0.6years). Based on changes in body mass index percentiles children were classified into a weight loss, constant weight, or weight gain group. Health behavior and family background were assessed via parent questionnaire. Group differences were examined via analysis of variance and multinomial logistic regression. RESULTS Weight gain was associated with low physical activity, lack of active transport, and lack of regular breakfast at follow-up. Children in the weight gain category also displayed lower fitness during baseline and follow-up, but differences were more pronounced during follow-up. TV time, migration background or parental education was not associated with weight gain. CONCLUSION Ensuring adequate physical activity and high fitness is an important aspect in the prevention of excessive weight gain during childhood. In addition to sports participation active transport should be emphasized in future weight management programs in children.

Design, Implementation, and Study Protocol of a Kindergarten-Based Health Promotion Intervention

Inactivity and an unhealthy diet amongst others have led to an increased prevalence of overweight and obesity even in young children. Since most health behaviours develop during childhood health promotion has to start early. The setting kindergarten has been shown as ideal for such interventions. “Join the Healthy Boat” is a kindergarten-based health promotion programme with a cluster-randomised study focussing on increased physical activity, reduced screen media use, and sugar-sweetened beverages, as well as a higher fruit and vegetable intake. Intervention and materials were developed using Bartholomews Intervention Mapping approach considering Banduras social-cognitive theory and Bronfenbrenners ecological framework for human development. The programme is distributed using a train-the-trainer approach and currently implemented in 618 kindergartens. The effectiveness of this one-year intervention with an intervention and a control group will be examined in 62 kindergartens using standardised protocols, materials, and tools for outcome and process evaluation. A sample of 1021 children and their parents provided consent and participated in the intervention. Results of this study are awaited to give a better understanding of health behaviours in early childhood and to identify strategies for effective health promotion. The current paper describes development and design of the intervention and its implementation and planned evaluation. Trial Registration. The study is registered at the German Clinical Trials Register (DRKS), Freiburg University, Germany, ID: DRKS00010089.

Illness and determinants of health-related quality of life in a cross-sectional sample of schoolchildren in different weight categories.

Aim: To study associations between health-related quality of life (HRQoL), frequency of illness, and weight in primary school children in southern Germany. Methods: Data from baseline measurements of the outcome evaluation of a teacher based health promotion programme (“Join the Healthy Boat”) were analysed. Parents provided information about their children’s HRQoL (KINDLR, EQ5D-Y Visual Analogue Scale). The number of visits to a physician, children’s days of absence because of sickness, and parental days of absence from work due to their children’s illness during the last year of school/kindergarten were queried. Children’s weight status was determined by body mass index (BMI), central obesity by waist to height ratio (WHtR ≥0.5). Results: From 1,888 children (7.1±0.6 years), 7.8% were underweight, 82% had normal weight, 5.7% were overweight and 4.4% obese. 8.4% of all children were centrally obese. Bivariate analysis showed no significant differences for parental absence and visits to a physician in weight groups classified by BMI, but obese children had more sick days than non-obese. Centrally obese children differed significantly from the rest in the number of sick days and visits to a physician, but not in the frequency of parental absence. In regression analyses, central obesity correlated significantly with EQ5D-Y VAS, KINDLR total score and the subscales of “psyche”, “family” and “friends”. BMI weight groups showed no significant associations. Conclusions: Central obesity but not BMI derived overweight and obesity is associated with HRQoL and visits to a physician in primary school children. Future studies should include WHtR. Preventive measures for children should focus on a reduction of or slowed increase in waist circumference.

Why do mothers encourage their children to control their weight? A cross-sectional study of possible contributing factors

BackgroundMothers encouraging their children to control their weight is problematic as it is associated with children’s body dissatisfaction and weight concerns as well as further weight gain. The aim of this study was to identify factors in children and mothers associated with mothers encouraging their children to control their weight and possible gender differences therein.MethodsCross-sectional questionnaire data was available from 1658 mothers of primary school children (mean age 7.1 ±0.6 years, 50.4% boys) participating in the Baden-Württemberg Study. Children’s body weight and height were measured in a standardised manner. Logistic regressions were computed separately for boys and girls, adjusted odds ratios (OR) and 95% confidence intervals (CI) from the final model are reported.Results29% of children were encouraged by their mothers, girls (32.4%) significantly more often than boys (25.6%). Child BMI (girls OR 1.77, CI 1.57 to 1.99; boys OR 1.88, CI 1.66 to 2.13), and child migration background (girls OR 2.14, CI 1.45 to 3.16; boys OR 1.60, CI 1.07 to 2.37) were significantly associated with encouragement by mothers. For girls, maternal body dissatisfaction (OR 1.59, CI 1.10 to 2.30) and maternal perception of a low influence on health (OR 0.51, CI 0.29 to 0.89) were also significantly associated with maternal encouragement. For boys, this was true of mothers self-efficacy to influence their children’s physical activity (OR 0.58, CI 0.40 to 0.85).ConclusionDifferent factors are associated with mothers encouraging boys and girls to control their weight. Identifying correlates and underlying processes of maternal encouragement can inform preventive measures targeting weight and eating related problems in children.

Intervention effects of a school-based health promotion program on children’s motor skills

PurposePhysical activity (PA) has positive effects on children’s development. Particularly in childhood, PA plays an important role for children’s motor skills. The objective of this study was to examine the influence of the intervention program “Join the Healthy Boat” on motor abilities of primary school children.MethodsThe baseline measurements of this longitudinal intervention study with an intervention (IG) and control group (CG) were taken at the beginning of the school year 2010/2011 (T1) and follow up measurements in 2011/2012 (T2). Efficacy of the intervention on children’s motor abilities was assessed using a standardized and validated test battery (Dordel-Koch-Test). An exploratory factor analysis was performed in order to reduce dimensions. Differences between CG and IG were examined using analysis of covariance adjusting for age, gender, BMI percentiles and baseline data.ResultsChildren in the IG showed an significant improvement in the conditional skills (F(1,1571) = 5.20, p ≤ 0.02) and less decline in flexibility (F(1,1715) = 6.68, p ≤ 0.01) than children in the CG. Additionally, positive differences in the flexibility tests were ascertained for girls, F(1,839) = 100.88, p ≤ 0.02).ConclusionThe study showed that an intervention that aims to increase PA affects certain parts of children’s motor skills significantly. This was achieved without any extra PA lessons at school but with a low-threshold intervention integrated into the daily school routine.

Objectively Determined Physical Activity Levels in German Primary School Children after a One Year School-based Health Promoting Intervention

Beneficial effects of regular physical activity (PA) during childhood have widely been recognised. In spite of this many are not sufficiently physically active; therefore, health promotion has to start early. The programme “Join the Healthy Boat” promotes– amongst other aspects – an increase of daily PA in primary school children. In order to evaluate the effectiveness of the programme, this study investigated children’s PA behaviours objectively. During one school year, teachers delivered lessons and action alternatives in order to promote daily PA. A subsample of 318 children participated in the clusterrandomised study; at follow-up, 167 of them (8.0 ± 0.6 years, male: 46.1%) were assessed again. Children’s height and weight were measured on site; PA was assessed on six consecutive days using multi-sensor accelerometry (Actiheart©, CamNtech). PA was defined as the amount of energy expended. All other parameters were assessed using a parental questionnaire. At follow-up, significant effects were found for moderate to vigorous PA (MVPA) and gender as well as MVPA and weight status, with boys being more active than girls and overweight/obese children being more active than normal weight children (T-5.646 p<0.01; T-3.998 p<0.01, respectively). Further, more overweight/obese children as well as children in the intervention group reached the recommended activity guidelines of 60 minutes daily in MVPA; yet no statistical significance was reached. However, comparing control and intervention group, no significant intervention effects were found after one year. A multi-dimensional intervention for one year does not seem to achieve significant increases in children’s objectively assessed PA. Maybe a longer lasting, more intense intervention with extra lessons would show more positive effects. Also, assessing PA directly after seven weeks of summer holidays (with no intervention) might have led to lower PA levels than straight after the intervention at the end of the previous school year.