Simon C, Schweitzer B, Oujaa M, Wagner A, Arveiler D, Triby E, Copin N, Blanc S, Platat C
Louis Pasteur University of Strasbourg, Strasbourg, France.
Int J Obes (Lond). 2008 Oct;32(10):1489-98. doi: 10.1038/ijo.2008.99. Epub 2008 Jul 15.
Population-based studies directed at promoting physical activity in youth have shown limited success in obesity prevention.
To assess whether an intervention integrating environmental changes to induce sustained changes in physical activity, prevents overweight in adolescents.
Four-year randomized trial started in 2002 in eight middle schools of Eastern France. The intervention, randomized at school level, was designed to promote physical activity by changing attitudes through debates and attractive activities, and by providing social support and environmental changes encouraging physical activity.
Nine hundred and fifty four 12-year-old six-graders.
Body mass index (BMI), body composition, physical activity by questionnaire, plasma lipids and glucose, insulin resistance.
Intervention students had a lower increase in BMI (P=0.01) and age- and gender-adjusted BMI (P<0.02) over time than controls. The differences across groups of the age- and gender-adjusted BMI changes (95% confidence interval (CI)) were -0.29 (-0.51; -0.07) kg/m2 at 3 years, -0.25 (-0.51; 0.01) kg/m2 at 4 years. An interaction with baseline weight status was noted. The intervention had a significant effect throughout the study in initially non-overweight adolescents (-0.36 (-0.60;-0.11) kg/m2 for adjusted BMI at 4 years), corresponding to a lower increase in fat mass index (P<0.001). In initially overweight adolescents, the differences observed across groups at 2 years (-0.40 (-0.94; 0.13) kg/m2 for adjusted BMI) did not persist over time. At 4 years, 4.2% of the initially non-overweight adolescents were overweight in the intervention schools, 9.8% in the controls (odds ratio=0.41 (0.22; 0.75); P<0.01). Independent of initial weight status, compared with controls, intervention adolescents had an increase in supervised physical activity (P<0.0001), a decrease of TV/video viewing (P<0.01) and an increase of high-density cholesterol concentrations (P<0.0001).
Enhancing physical activity with a multilevel program prevents excessive weight gain in non-overweight adolescents. Our study provides evidence that prevention of obesity in youth is feasible.
以促进青少年体育活动为目标的基于人群的研究在预防肥胖方面成效有限。
评估一项整合环境变化以促使体育活动持续改变的干预措施能否预防青少年超重。
2002年在法国东部的八所中学开展的为期四年的随机试验。该干预措施在学校层面进行随机分组，旨在通过辩论和有趣的活动改变态度、提供社会支持以及营造鼓励体育活动的环境变化来促进体育活动。
954名12岁的六年级学生。
体重指数（BMI）、身体成分、通过问卷评估的体育活动情况、血脂和血糖、胰岛素抵抗。
随着时间推移，干预组学生的BMI增幅（P = 0.01）以及年龄和性别调整后的BMI增幅（P < 0.02）均低于对照组。年龄和性别调整后的BMI变化的组间差异（95%置信区间（CI））在3年时为-0.29（-0.51；-0.07）kg/m²，在4年时为-0.25（-0.51；0.01）kg/m²。观察到与基线体重状况存在交互作用。在整个研究过程中，该干预措施对初始体重正常的青少年有显著效果（4年时调整后的BMI为-0.36（-0.60；-0.11）kg/m²），这对应着较低的脂肪量指数增幅（P < 0.001）。在初始超重的青少年中，2年时观察到的组间差异（调整后的BMI为-0.40（-0.94；0.13）kg/m²）并未随时间持续。4年时，干预学校中初始体重正常的青少年有4.2%超重，对照组为9.8%（优势比 = 0.41（0.22；0.75）；P < 0.01）。与初始体重状况无关，与对照组相比，干预组青少年的受监督体育活动增加（P < 0.0001），看电视/录像的时间减少（P < 0.01），高密度胆固醇浓度增加（P < 0.0001）。
通过多层次项目增强体育活动可预防非超重青少年体重过度增加。我们的研究提供了证据表明青少年肥胖预防是可行的。
