Heelan Kate A, Bartee R Todd, Nihiser Allison, Sherry Bettylou
1 Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney , Kearney, NE.
2 Division of Population Health, Centers for Disease Control and Prevention , Atlanta, GA.
Child Obes. 2015 Oct;11(5):600-7. doi: 10.1089/chi.2015.0005.
Schools play a role in addressing childhood obesity by implementing healthy eating and physical activity strategies. The primary aim of this case study was to describe prevalence of overweight and obesity among elementary school students in a rural Mid-western community between 2006 and 2012. The secondary aim was to use a novel approach called "population dose" to retrospectively evaluate the impact dose of each strategy implemented and its estimated potential population level impact on changes in overweight and obesity.
Weight and height were directly measured annually beginning in January 2006 to assess weight status, using BMI (kg/m(2)), for all kindergarten to fifth-grade students (N ≈ 2400 per year). Multiple evidence-based strategies were implemented in nine schools to increase physical activity and healthy eating behaviors. BMI reporting and revised school meal programs were implemented districtwide. Comprehensive school physical activity programs, school food environment, and supportive/promotional strategies were implemented at individual schools.
The absolute change in prevalence of obesity (BMI ≥95th percentile) decreased from 16.4% to 13.9%, indicating a 15.2% relative change in prevalence of obesity in 6 years. There was an inverse relationship between the number of strategies implemented and prevalence of overweight and obesity over time.
District and school-level approaches have the potential to impact childhood obesity. Schools can successfully implement strategies to address overweight and obesity, but the extent of implementation between schools may vary. Population dose analysis can be used to estimate impact of clusters of strategies to address overweight/obesity.
学校通过实施健康饮食和体育活动策略在解决儿童肥胖问题中发挥作用。本案例研究的主要目的是描述2006年至2012年间中西部农村社区小学生中超重和肥胖的患病率。次要目的是使用一种名为“人群剂量”的新方法，回顾性评估所实施的每项策略的影响剂量及其对超重和肥胖变化的估计潜在人群水平影响。
从2006年1月开始，每年直接测量所有幼儿园至五年级学生（每年约N = 2400）的体重和身高，使用体重指数（BMI，kg/m²）来评估体重状况。在九所学校实施了多种基于证据的策略，以增加体育活动和健康饮食行为。在全学区实施了BMI报告和修订后的学校膳食计划。在个别学校实施了全面的学校体育活动计划、学校食物环境以及支持/推广策略。
肥胖患病率（BMI≥第95百分位数）的绝对变化从16.4%降至13.9%，表明6年中肥胖患病率的相对变化为15.2%。随着时间的推移，所实施策略的数量与超重和肥胖患病率之间存在反比关系。
学区和学校层面的方法有可能影响儿童肥胖问题。学校可以成功实施解决超重和肥胖问题的策略，但学校之间的实施程度可能有所不同。人群剂量分析可用于估计解决超重/肥胖问题的策略集群的影响。
