基于加州公立学校的体重指数报告对学生的影响：一项随机临床试验。

Effect of School-Based Body Mass Index Reporting in California Public Schools: A Randomized Clinical Trial.

机构信息

Berkeley Food Institute, University of California, Berkeley, Berkeley.

Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley.

出版信息

JAMA Pediatr. 2021 Mar 1;175(3):251-259. doi: 10.1001/jamapediatrics.2020.4768.

DOI:10.1001/jamapediatrics.2020.4768

PMID:33196797

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7670394/

Abstract

IMPORTANCE

Annually, US schools screen millions of students' body mass index (BMI) and report the results to parents, with little experimental evidence on potential benefits and harms.

OBJECTIVE

To determine the impact of school-based BMI reporting on weight status and adverse outcomes (weight stigmatization and weight-related perceptions and behaviors) among a diverse student population.

DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized clinical trial. The Fit Study (2014-2017) randomized 79 California schools to BMI screening and reporting (group 1), BMI screening only (group 2), or control (no BMI screening or reporting [group 3]) in grades 3 to 8. The setting was California elementary and middle schools. Students in grades 3 to 7 at baseline participated for up to 3 years. A modified intent-to-treat protocol was used. Data analysis was conducted from April 13, 2017, to March 26, 2020.

INTERVENTIONS

School staff assessed BMI each spring among students in groups 1 and 2. Parents of students in group 1 were sent a BMI report each fall for up to 2 years.

MAIN OUTCOMES AND MEASURES

Changes in BMI z score and in adverse outcomes (based on surveys conducted each fall among students in grades 4 to 8) from baseline to 1 and 2 years of follow-up.

RESULTS

A total of 28 641 students (14 645 [51.1%] male) in grades 3 to 7 at baseline participated in the study for up to 3 years. Among 6534 of 16 622 students with a baseline BMI in the 85th percentile or higher (39.3%), BMI reporting had no effect on BMI z score change (-0.003; 95% CI, -0.02 to 0.01 at 1 year and 0.01; 95% CI, -0.02 to 0.03 at 2 years). Weight dissatisfaction increased more among students having BMI screened at school (8694 students in groups 1 and 2) than among control participants (5674 students in group 3). Results of the effect of BMI reporting on other adverse outcomes were mixed: compared with the control (group 3), among students weighed at school (groups 1 and 2), weight satisfaction declined more after 2 years (-0.11; 95% CI, -0.18 to -0.05), and peer weight talk increased more after 1 year (0.05; 95% CI, 0.01-0.09); however, concerning weight control behaviors declined more after 1 year (-0.06; 95% CI, -0.10 to -0.02).

CONCLUSIONS AND RELEVANCE

Body mass index reports alone do not improve children's weight status and may decrease weight satisfaction. To improve student health, schools should consider investing resources in evidence-based interventions.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02088086.

摘要

重要性

美国学校每年对数百万学生的身体质量指数（BMI）进行筛查，并将结果告知家长，但几乎没有关于潜在益处和危害的实验证据。

目的

确定基于学校的 BMI 报告对不同学生群体的体重状况和不良结果（体重污名化以及与体重相关的认知和行为）的影响。

设计、设置和参与者：这是一项整群随机临床试验。Fit 研究（2014-2017 年）将 79 所加利福尼亚学校随机分为 BMI 筛查和报告组（第 1 组）、BMI 筛查组（第 2 组）和对照组（不进行 BMI 筛查或报告[第 3 组]），这些学校分布在加利福尼亚州的小学和中学。基线时有 3 至 7 年级的学生参与，时间最长为 3 年。采用改良意向治疗方案。数据分析于 2017 年 4 月 13 日至 2020 年 3 月 26 日进行。

干预措施

第 1 组和第 2 组的学校工作人员每年春季对学生的 BMI 进行评估。第 1 组学生的家长在秋季收到一份 BMI 报告，时间最长为 2 年。

主要结果和措施

从基线到 1 年和 2 年随访时，BMI z 分数和不良结果（基于 4 至 8 年级学生每年秋季进行的调查）的变化。

结果

共有 28641 名 3 至 7 年级的学生（男性 14645 名[51.1%]）参与了这项研究，时间最长为 3 年。在基线 BMI 位于第 85 百分位或更高的 16622 名学生中的 6534 名（39.3%）中，BMI 报告对 BMI z 分数的变化没有影响（第 1 年为-0.003；95%CI，-0.02 至 0.01，第 2 年为 0.01；95%CI，-0.02 至 0.03）。与对照组（第 3 组）相比，在学校接受 BMI 筛查的学生（第 1 组和第 2 组中的 8694 名学生）中，体重不满的情况增加更多。BMI 报告对其他不良结果的影响结果不一：与对照组（第 3 组）相比，在学校接受体重测量的学生（第 1 组和第 2 组）中，体重满意度在 2 年后下降更多（-0.11；95%CI，-0.18 至 -0.05），在 1 年后，同伴间关于体重的讨论增加更多（0.05；95%CI，0.01-0.09）；然而，在 1 年后，关注体重控制行为的学生减少更多（-0.06；95%CI，-0.10 至 -0.02）。