Tamara Wirt

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.

Associations between inhibitory control and body weight in German primary school children

Deficits in inhibitory control are supposed to be a risk factor for overweight but literature concerning childhood and beyond the clinical setting is scarce. The objective of this study was to investigate the role of inhibitory control in regards to body weight in a large non-clinical sample of primary school children. Baseline data of 498 children (1st and 2nd grade; 7.0 ± 0.6 years; 49.8% boys) participating in a school-based intervention study in Germany were used. Children performed a Go-Nogo-task to assess inhibitory control. Height and weight were collected and converted to BMI percentiles based on national standards. Relevant influencing factors (sociodemographic data, health characteristics of parents, childrens health behaviour) were assessed via parental questionnaire. Inhibitory control was significantly associated with body weight and contributed to the statistical prediction of body weight above and beyond parent education, migration background, parent weight, TV consumption and breakfast habits. Moreover, obese children displayed significantly lower inhibitory control compared to non-overweight and overweight children. The findings suggest that deficits in inhibitory control constitute a risk factor for paediatric obesity.

Early Life Cognitive Abilities and Body Weight: Cross-Sectional Study of the Association of Inhibitory Control, Cognitive Flexibility, and Sustained Attention with BMI Percentiles in Primary School Children

The objective of this study was to investigate the association of different cognitive abilities with childrens body weight adjusted for further weight influencing sociodemographic, family, and lifestyle factors. Cross-sectional data of 498 primary school children (7.0 ± 0.6 years; 49.8% boys) participating in a health promotion programme in southwest Germany were used. Children performed a computer-based test battery (KiTAP) including an inhibitory control task (Go-Nogo paradigm), a cognitive flexibility task, and a sustained attention task. Height and weight were measured in a standardized manner and converted to BMI percentiles based on national standards. Sociodemographic features (migration background and parental education), family characteristics (parental body weight), and childrens lifestyle (TV consumption, physical activity, consumption of sugar-sweetened beverages and breakfast habits) were assessed via parental questionnaire. A hierarchical regression analysis revealed inhibitory control and cognitive flexibility to be significant cognitive predictors for childrens body weight. There was no association concerning sustained attention. The findings suggest that especially cognitive abilities known as executive functions (inhibitory control and cognitive flexibility) are associated with childrens body weight. Future longitudinal and intervention studies are necessary to investigate the directionality of the association and the potential of integrating cognitive training in obesity prevention strategies. This trial is registered with ClinicalTrials.gov DRKS00000494.

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.

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.

Health Promotion in Primary Schools- Evaluation of Side-Effects on Cognitive and Academic Performance in a Randomized Trial

Background: School-based lifestyle interventions are a cost-effective way to prevent pediatric overweight. The program “Join the Healthy Boat” focuses on physical activity, healthy diet and screen media use in German primary school children, implemented by regular classroom teachers including teaching units, physical activity exercises, and work with parents. Objective of the study was to measure potential side-effects on children’s cognitive and academic performance. Methods: The program was evaluated in a RCT design, measurements took place before and after one year of intervention. Stratification of randomization was carried out for number of classes and grade level. Participants were 1st and 2nd graders of primary schools. Intervention and assessment took place on site at school; questionnaires were issued. N=442 children performed a computer based test battery measuring inhibitory control, cognitive flexibility and sustained attention. Academic achievement was assessed via parental questionnaire. Results: Multiple regression analyses controlling for age, gender and parental education and Mann-Whitney-Utests revealed no significant differences between intervention and control group in cognitive changes or academic development from baseline to follow up. In Cognitive Flexibility, however, the number of children who improved was higher in the intervention group. Conclusion: Taking time from the regular school curriculum for health promotion had no negative impacts on children’s cognitive or academic development. To obtain more positive effects a longer period of time and a more intense intervention are presumably necessary. The findings are in line with a recent review indicating no negative effects of school health programs. Eventually there is a positive impact of physical activity interventions on specific cognitive functions but findings regarding academic outcomes are still inconclusive. Weak evidence is reported for nutrition services.

Response to: Comment on “Intervention Effects of a School-Based Health Promotion Programme on Obesity Related Behavioural Outcomes”

Evaluating multicomponent health programmes in public institutions is always a complex task and requires careful planning [1]. Reporting the outcomes in a precise and understandable manner is a further challenge for the researcher [2]. The points raised by Li et al. [3] are very valid and were also considered by us when writing the paper. Although outlined by Dreyhaupt et al. [4], not all planned analyses were incorporated in our paper [5]. Since the paper [5] (especially Methods) ended up being considerably substantial, we refrained from adding results of further statistical analyses to the paper. Further, in previous paper concerning cross-sectional results of this study, we referred to the respective consideration of clustering effects including adequate statistical methods [6, 7]. Since almost no clustering effects were observed, we refrained from introducing them in the present paper, even due to the associated complexity [2]. However, we have compared the results of the logistic regression models used and published in the paper with the results of generalised linear mixed models considering possible clustering effects in schools. Only a slight difference between odds ratios (ORs) was derived from the logistic regression models and the ORs from generalised linear mixed models for the variables “soft drink consumption” and “skipping breakfast.” Hence, we refrained from explaining and mentioning it in the paper. To reveal these above-mentioned slight differences between the results published in the paper and those derived from mixed models accounting for clustering, we included Table 1, which shows the results from both types of analysis. The ORs for our outcome variables physical activity, screen media use, soft drink consumption, and breakfast habits show no significant differences, and therefore we assume no clustering effects in our data. Table 1 Comparison of the results derived from logistic regression models and generalised linear mixed models.