Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.
Int J Behav Nutr Phys Act. 2021 Jan 4;18(1):1. doi: 10.1186/s12966-020-01065-9.
Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness.
A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score.
Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (- 0.06 [95% CI -0.10, - 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated.
Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.
由于食物选择、身体活动水平和暴露于致肥胖环境的变化，青少年越来越容易肥胖，因此有患非传染性疾病的风险。本综述旨在综合研究学校环境中实施的健康教育干预措施预防超重和肥胖和/或降低青少年 BMI 的有效性的文献，并探讨其有效性的关键特征。
2020 年，根据 PRISMA 指南，对 2006 年 1 月以来发表的电子数据库（包括 MEDLINE、CINAHL、PsychINFO 和 ERIC）进行了系统搜索，以检索有关在高收入国家学校中为 10-19 岁青少年提供的健康教育干预措施以预防超重和肥胖和/或降低 BMI 的研究。选择了有对照组并报告 BMI/BMI z 分数的评估健康教育干预措施的研究。三名研究人员筛选标题和摘要，进行数据提取，并评估全文出版物的质量。一组论文的三分之一由另一名评审员交叉检查。对 BMI z 分数的亚组研究进行了荟萃分析。
综述共纳入 33 项干预措施，共 39 篇文献。大多数研究评估了使用健康教育改善与饮食、身体活动和身体成分测量相关的行为的多组分干预措施。有 14 项干预措施与 BMI/BMI z 分数降低有关。大多数干预措施（n=22）由教师在课堂环境中进行，其中 19 项在干预前对教师进行了培训。多组分干预措施（n=26）包括环境修改（n=10）、数字干预措施（n=15）和家长参与（n=16）等策略。14 项研究的偏倚风险较低，其次是 10 项中等风险和 9 项高风险。14 项研究纳入 BMI z 分数的随机效应荟萃分析。荟萃分析的汇总估计显示，干预组和对照组在 BMI z 分数变化方面存在微小差异（-0.06[95%CI-0.10，-0.03]）。漏斗图表明存在一定程度的发表偏倚，因此效应大小可能会被夸大。
本综述的结果表明，以学校为基础的健康教育干预措施具有降低青少年 BMI 至更健康范围的公共卫生潜力。涉及教师和家长等主要利益攸关方和数字组成部分的多组分干预措施是一种有前途的策略。
