Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter June 8, 2020

Effect of a school-based intervention in eating habits among school children: quasi experimental study, Tunisia

Asma Ben Cheikh, Jihène Maatoug, Rim Ghammam, Firas Chouikha, Amal Mallat and Hassen Ghannem

Abstract

Objective

The present study aimed to assess whether six months intervention program with parents' implication in primary schools is able to decrease morning snack consumption among children aged 6–12 years.

Methods

We carried out a quasi-experimental study with two groups of schoolchildren in the region of Sousse (Tunisia) from 2015 to 2016. One primary school in each group was selected. In each school, we randomly selected a sample size of schoolchildren and their parents. The intervention was based on healthy eating habits promotion.

Results

The consumption of morning snacks the day before data collection, reported by children, decreased significantly in post-intervention in both intervention and control groups. The decrease of consumption of morning snacks was significantly higher in intervention group (p=0.009). According to parents, the proportion of children who had the habit of eating morning snack decreased significantly from pre to post-intervention in intervention group (p<0.001).

Conclusion

A healthy environment should be created through effective school policies to prevent obesity.


Corresponding author: Asma Ben Cheikh, Assistant in Preventive and Community Medicine, University of Sousse, Faculty of Medicine of Sousse, Tunisia, Phone: +216 97455045, E-mail:

Funding source: World Health Organization

Acknowledgment

This project was funded by World Health Organization EMRO RPPH Grant 2015/527441-0.

References

1. Thibault H, Carriere C, Langevin C, Kossi Déti E, Barberger-Gateau P, Maurice S. Prevalence and factors associated with overweight and obesity in French primary-school children. Public Health Nutr 2013;16:193–201. https://doi.org/10.1017/S136898001200359X.Search in Google Scholar PubMed

2. Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev 2012;33:48–70. https://doi.org/10.1210/er.2010-0028.Search in Google Scholar PubMed

3. Nasreddine L, Naja F, Chamieh MC, Adra N, Sibai A-M, Hwalla N. Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009). BMC Public Health 2012;12:798. https://doi.org/10.1186/1471-2458-12-798.Search in Google Scholar PubMed PubMed Central

4. Maatoug J, Msakni Z, Zammit N, Bhiri S, Harrabi I, Boughammoura L, et al. School-based intervention as a component of a comprehensive community program for overweight and obesity prevention, sousse, Tunisia. 2009-2014. Prev Chronic Dis. 2015;12:E160. https://doi.org/10.5888/pcd12.140518.Search in Google Scholar PubMed PubMed Central

5. Steyn NP, de Villiers A, Gwebushe N, Draper CE, Hill J, de Waal M, et al. Did healthkick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?. BMC Public Health 2015;15:948. https://doi.org/10.1186/s12889-015-2282-4.Search in Google Scholar PubMed PubMed Central

6. Moreno JP, Mohammed A, Moore CE, Johnston C, 2015. Benefits of a snacking intervention as part of a school-based obesity intervention for Mexican American children. J Appl Res Child Informing Policy Child Risk ;6. https://digitalcommons.library.tmc.edu/childrenatrisk/vol6/iss2/15enn.Search in Google Scholar

7. Bay JL, Vickers MH. Adolescent education: an opportunity to create a developmental origins of Health and Disease (DOHaD) circuit breaker. J Dev Orig Health Dis 2016;7:501–4. https://doi.org/10.1017/S204017441600026X.Search in Google Scholar PubMed

8. Bessems KMHH, van Assema P, Martens MK, Paulussen TGWM, Raaijmakers LGM, de Rooij M, et al. Healthier food choices as a result of the revised healthy diet programme Krachtvoer for students of prevocational schools. Int J Behav Nutr Phys Act 2012;9:60. https://doi.org/10.1186/1479-5868-9-60.Search in Google Scholar PubMed PubMed Central

9. Willeboordse M, Jansen MW, van den Heijkant SN, Simons A, Winkens B, de Groot RHM, et al. The healthy primary school of the future: study protocol of a quasi-experimental study. BMC Public Health 2016;16:639. https://doi.org/10.1186/s12889-016-3301-9.Search in Google Scholar PubMed PubMed Central

10. Gregorič M, Pograjc L, Pavlovec A, Simčič M, Gabrijelčič Blenkuš M. School nutrition guidelines: overview of the implementation and evaluation. Public Health Nutr 2015;18:1582–92. https://doi.org/10.1017/S1368980014003310.Search in Google Scholar PubMed

11. Santaliestra-Pasías AM, Mouratidou T, Huybrechts I, Beghin L, Cuenca-García M, Castillo MJ, et al. Increased sedentary behaviour is associated with unhealthy dietary patterns in European adolescents participating in the HELENA study. Eur J Clin Nutr 2014;68:300–08. https://doi.org/10.1038/ejcn.2013.170.Search in Google Scholar PubMed

12. Bocquet A, Bresson J-L, Briend A, Chouraqui J-P, Darmaun D, Dupont C, et al. [The morning snack at school is inadequate and unnecessary]. Arch Pediatr Organe Off Soc Francaise Pediatr 2003;10:945–7. https://doi.org/10.1016/j.arcped.2003.07.004.Search in Google Scholar PubMed

13. Thibault H, Carriere C, Langevin C, Atchoarena S, Delmas C, Baratchart B-A, et al. La collation à l'école maternelle: évolution des perceptions et pratiques des enseignants d'Aquitaine entre 2004 et 2008. Arch Pédiatrie 2010;17:1516–21. https://doi.org/10.1016/j.arcped.2010.08.004.Search in Google Scholar PubMed

14. Kong A, Beresford SAA, Alfano CM, Foster-Schubert KE, Neuhouser ML, Johnson DB, et al. Associations between snacking and weight loss and nutrient intake among postmenopausal overweight-to-obese women in a dietary weight loss intervention. J Am Diet Assoc 2011;111:1898–903. https://doi.org/10.1016/j.jada.2011.09.012.Search in Google Scholar PubMed PubMed Central

15. Bocquet A, Bresson J-L, Briend A, Chouraqui J-P, Darmaun D, Dupont C, et al. La collation de 10 heures en milieu scolaire: un apport alimentaire inadapté et superflu. Arch Pédiatrie 2003;10:945–7. https://doi.org/10.1016/j.arcped.2003.07.004.Search in Google Scholar

16. Jomaa LH, McDonnell E, Probart C. School feeding programs in developing countries: impacts on children's health and educational outcomes. Nutr Rev 2011;69:83–98. https://doi.org/10.1111/j.1753-4887.2010.00369.x.Search in Google Scholar PubMed

17. Grillenberger M, Neumann CG, Murphy SP, Bwibo NO, van't Veer P, Hautvast JGAJ, et al. Food supplements have a positive impact on weight gain and the addition of animal source foods increases lean body mass of Kenyan schoolchildren. J Nutr 2003;133:3957S–64S. https://doi.org/10.1093/jn/133.11.3957S.Search in Google Scholar PubMed

18. Tarro L, Llauradó E, Albaladejo R, Moriña D, Arija V, Solà R, et al. A primary-school-based study to reduce the prevalence of childhood obesity – the EdAl (Educació en Alimentació) study: a randomized controlled trial. Trials 2014;15:58. https://doi.org/10.1186/1745-6215-15-58.Search in Google Scholar PubMed PubMed Central

19. Bachman JL, Raynor HA. Effects of manipulating eating frequency during a behavioral weight loss intervention: a pilot randomized controlled trial. Obesity 2012;20:985–92. http://doi.org/10.1038/oby.2011.360.10.1038/oby.2011.360Search in Google Scholar PubMed

20. Tak NI, Te Velde SJ, Singh AS, Brug J. The effects of a fruit and vegetable promotion intervention on unhealthy snacks during mid-morning school breaks: results of the Dutch Schoolgruiten Project. J Hum Nutr Diet Off J Br Diet Assoc 2010;23:609–15. https://doi.org/10.1111/j.1365-277X.2010.01090.x.Search in Google Scholar PubMed

21. Blanchette L, Brug J. Determinants of fruit and vegetable consumption among 6–12-year-old children and effective interventions to increase consumption. J Hum Nutr Diet 2005;18:431–43. http://doi.org/10.1111/j.1365-277X.2005.00648.x.10.1111/j.1365-277X.2005.00648.xSearch in Google Scholar PubMed

22. Aloia CR, Shockey TA, Nahar VK, Knight KB. Pertinence of the recent school-based nutrition interventions targeting fruit and vegetable consumption in the United States: a systematic review. Health Promot Perspect 2016;6:1–9. https://doi.org/10.15171/hpp.2016.01.10.15171/hpp.2016.01Search in Google Scholar PubMed PubMed Central

23. Øverby NC, Klepp K-I, Bere E. Introduction of a school fruit program is associated with reduced frequency of consumption of unhealthy snacks. Am J Clin Nutr 2012;96:1100–03. https://doi.org/10.3945/ajcn.111.033399.Search in Google Scholar PubMed

24. Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005;105:743–60. quiz 761-762. https://doi.org/10.1016/j.jada.2005.02.007.Search in Google Scholar PubMed

25. Arora M, Nazar GP, Gupta VK, Perry CL, Reddy KS, Stigler MH. Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study. BMC Public Health 2012;12:881. https://doi.org/10.1186/1471-2458-12-881.Search in Google Scholar PubMed PubMed Central

26. Lazzeri G, Giallombardo D, Guidoni C, Zani A, Casorelli A, Grasso A, et al. Nutritional surveillance in Tuscany: eating habits at breakfast, mid-morning and afternoon snacks among 8-9 y-old children. J Prev Med Hyg 2006;47:91–9. https://doi.org/10.15167/2421-4248/jpmh2006.47.3.73.Search in Google Scholar

27. Izumi BT, Findholt NE, Pickus HA. Formative evaluation to increase availability of healthy snacks and beverages in stores near schools in two rural Oregon counties, 2013. Prev Chronic Dis 2015;12:E215. https://doi.org/10.5888/pcd12.150252.Search in Google Scholar PubMed PubMed Central

28. Wind M, Bjelland M, Pérez-Rodrigo C, Te Velde SJ, Hildonen C, Bere E, et al. Appreciation and implementation of a school-based intervention are associated with changes in fruit and vegetable intake in 10- to 13-year old schoolchildren--the Pro Children study. Health Educ Res 2008;23:997–1007. https://doi.org/10.1093/her/cym078.Search in Google Scholar PubMed

29. Schlechter CR, Rosenkranz RR, Guagliano JM, Dzewaltowski DA. A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework. Prev Med 2016;91:233–43. https://doi.org/10.1016/j.ypmed.2016.08.030.Search in Google Scholar PubMed

Received: 2018-09-07
Accepted: 2018-10-04
Published Online: 2020-06-08

© 2020 Walter de Gruyter GmbH, Berlin/Boston

Scroll Up Arrow