Jump to ContentJump to Main Navigation
Show Summary Details
More options …

International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel


CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

Online
ISSN
2191-0278
See all formats and pricing
More options …
Volume 29, Issue 2

Issues

Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012–2014

Jihen Maatoug / Sihem Ben Fredj / Zeineb Msakni / Emna Dendana / Jihene Sahli / Imed Harrabi / Firas Chouikha / Lamia Boughamoura / Slim Slama
  • Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva, Geneva, Switzerland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Nathalie Farpour-Lambert / Hassen Ghannem
Published Online: 2015-09-11 | DOI: https://doi.org/10.1515/ijamh-2015-0035

Abstract

Background:

Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide.

Objective:

To demonstrate the feasibility and effectiveness of a school-based management program based on healthy lifestyle promotion for obese and overweight adolescents in Sousse, Tunisia.

Methods:

We conducted a quasi-experimental study among overweight and obese school children enrolled in 7th and 8th grades in Sousse, Tunisia with two groups, intervention and control. The 1-year intervention was based on promoting healthy eating and physical activity through a collective intervention for all recruited children and an individual intervention only for obese children who require intensive managing. Data collection was done before, at the end and at a 4-month follow up of the intervention, both in intervention and control groups.

Results:

The body mass index Z score decreased significantly from pre-intervention to post-intervention (1.89±0.57 to 1.76±0.63, p<0.001) and from post-intervention to the follow-up (1.76±0.63 to 1.55±0.68, p<0.001) in the intervention group. In the control group, it decreased significantly from pre-intervention to post-intervention but not significantly from post-intervention to follow-up assessment. Calorie intake decreased significantly both in intervention and control groups.

Conclusion:

This project began with introducing a new culture of health management in schools on one side and with increasing awareness of the importance of obesity prevention and treatment. The support of authorities for this type of action is very important to guarantee its sustainability.

Keywords: adolescent; intervention; obesity; schools

References

  • 1.

    Bray GA. Obesity increases risk for diabetes. Int J Obes Relat Metab Disord 1992;16(Suppl 4):S13–7.PubMedGoogle Scholar

  • 2.

    Reilly J, Methven E, McDowell Z, Hacking B, Alexander D, et al. Health consequences of obesity. Arch Dis Child 2003;88: 748–52.PubMedCrossrefGoogle Scholar

  • 3.

    Thibault H, Rolland-Cachera MF. Prevention strategies of childhood obesity. Arch Pediatr 2003;10:1100–8.PubMedGoogle Scholar

  • 4.

    Lobstein T, Frelut ML. Prevalence of overweight among children in Europe. Obes Rev 2003;4:195–200.PubMedCrossrefGoogle Scholar

  • 5.

    Lobstein T, Baur L, Uauy R, IASO International Obesity TaskForce. Obesity in children and young people: a crisis in public health. Obes Rev Off J Int Assoc Study Obes 2004;5(Suppl 1): 4–104.CrossrefGoogle Scholar

  • 6.

    Aounallah-Skhiri H, El Ati J, Traissac P, Ben Romdhane H, Eymard-Duvernay S, et al. Blood pressure and associated factors in a North African adolescent population. A national cross-sectional study in Tunisia. BMC Public Health 2012;12:98.Web of ScienceCrossrefGoogle Scholar

  • 7.

    Harrabi I, Bouaouina M, Maatoug J, Gaha R, Ghannem H. Prevalence of the metabolic syndrome among urban schoolchildren in Sousse, Tunisia. Int J Cardiol 2009;135:130–1.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 8.

    Colagiuri S, Lee CMY, Colagiuri R, Magliano D, Shaw JE, et al. The cost of overweight and obesity in Australia. Med J Aust 2010;192:260–4.PubMedGoogle Scholar

  • 9.

    Allender S, Rayner M. The burden of overweight and obesity-related ill health in the UK. Obesity Reviews 2007;8:467–73.Web of ScienceCrossrefGoogle Scholar

  • 10.

    Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, et al. Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics 2005;115:e443–9.CrossrefGoogle Scholar

  • 11.

    Knöpfli BH, Radtke T, Lehmann M, Schatzle B, Eisenblatter J, et al. Effects of a multidisciplinary inpatient intervention on body composition, aerobic fitness, and quality of life in severely obese girls and boys. J Adolesc Health 2008;42:119–27.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 12.

    Pyle SA, Sharkey J, Yetter G, Felix E, Furlong MJ, et al. Fighting an epidemic: the role of schools in reducing childhood obesity. Psychol Sch 2006;43:361–76.CrossrefGoogle Scholar

  • 13.

    Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obesity Rev 2009;10:110–41.CrossrefWeb of ScienceGoogle Scholar

  • 14.

    Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2005;3:CD001871.Web of ScienceGoogle Scholar

  • 15.

    Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: an evidence-based review. Obesity (Silver Spring) 2008;16:1009–18.CrossrefPubMedGoogle Scholar

  • 16.

    Salmon J, Booth ML, Phongsavan P, Murphy N, Timperio A. Promoting physical activity participation among children and adolescents. Epidemiol Rev 2007, 29:144–59.CrossrefWeb of SciencePubMedGoogle Scholar

  • 17.

    Wilfley D, Tibbs T, Van Buren D, Reach K, Walker M, et al. Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials. Health Psychol 2007;26:521–32.Web of ScienceCrossrefPubMedGoogle Scholar

  • 18.

    Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley C, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872.Web of ScienceGoogle Scholar

  • 19.

    Baker JL, Farpour-Lambert NJ, Nowicka P, Pietrobelli A, Weiss R. Evaluation of the overweight/obese child--practical tips for the primary health care provider: recommendations from the Childhood Obesity Task Force of the European Association for the Study of Obesity. Obes Facts 2010;3:131–7.Web of ScienceGoogle Scholar

  • 20.

    Farpour-Lambert N, Nydegger A, Puder J, Kriemler S, L’Allemand D. Comment traiter l’obésité de l’enfant? Importance de la prévention primaire. Rev Med Suisse 2008;4:533–6.Google Scholar

  • 21.

    Hopitaux universitaires Genève. Contrepoids program. http://contrepoids.hug-ge.ch/informations/obesite_enfants_ados.html.

  • 22.

    Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin X, Herrmann F, et al. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am College Cardiol 2009;54:2396–406.CrossrefWeb of ScienceGoogle Scholar

  • 23.

    Group. WMGRS: WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Organization GWH, 2006:312. Available at: http://www.who.int/childgrowth/standards/Technical_report.pdf.

  • 24.

    Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, et al. Physical activity assessment methodology in the Five-City Project. Am J Epidemiol 1985;121:91–106.PubMedCrossrefGoogle Scholar

  • 25.

    Prochaska JO, Diclemente CC. Toward a Comprehensive Model of Change. In: Miller WR, Heather N, editor. Treating Addictive Behaviors. New York: Springer, 1986:3–27.Google Scholar

  • 26.

    Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, et al. Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr 2003;78:1030–8.CrossrefPubMedGoogle Scholar

  • 27.

    McGovern L, Johnson JN, Paulo R, Hettinger A, Singhal V, et al. Treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab 2008;93:4600–5.Web of ScienceCrossrefPubMedGoogle Scholar

  • 28.

    Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley C, et al. Interventions for treating obesity in children. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 1996.Google Scholar

  • 29.

    Aounallah-Skhiri H, Traissac P, El Ati J, Eymard-Duvernay S, Landais E, et al. Nutrition transition among adolescents of a south-Mediterranean country: dietary patterns, association with socio-economic factors, overweight and blood pressure. A cross-sectional study in Tunisia. Nutr J 2011;10:38.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 30.

    Ghannem H, Fredj AH. Epidemiological transition and cardiovascular risk factors in Tunisia. Rev Epidemiol Sante Publique 1997;45:286–92.PubMedGoogle Scholar

  • 31.

    Kelishadi R, Azizi Soleiman F. Controlling childhood obesity: a systematic review on strategies and challenges. J Res Med Sci 2014;19:993–1008.PubMedGoogle Scholar

  • 32.

    Plachta-Danielzik S, Landsberg B, Lange D, Seiberl J, Müller MJ. Eight-year follow-up of school-based intervention on childhood overweight – The Kiel Obesity Prevention Study. Obes Facts 2011;4:35–43.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 33.

    Muckelbauer R, Libuda L, Clausen K, Reinehr T, Kersting M. A simple dietary intervention in the school setting decreased incidence of overweight in children. Obes Facts 2009;2: 282–5.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 34.

    Plachta-Danielzik S, Pust S, Asbeck I, Czerwinski-Mast M, Langnäse K, et al. Four-year follow-up of school-based intervention on overweight children: the KOPS study. Obesity (Silver Spring) 2007;15:3159–69.PubMedCrossrefGoogle Scholar

  • 35.

    Gruber KJ, Haldeman LA. Using the family to combat childhood and adult obesity. Prev Chronic Dis 2009;6:A106.PubMedGoogle Scholar

  • 36.

    Ball GD, Ambler KA, Keaschuk RA, Rosychuk RJ, Holt NL, et al. Parents as agents of change (PAC) in pediatric weight management: the protocol for the PAC randomized clinical trial. BMC Pediatr 2012;12:114.Web of SciencePubMedCrossrefGoogle Scholar

  • 37.

    Braden AL, Crow S, Boutelle K. Child self-reported motivations for weight loss: impact of personal vs. social/familial motives on family-based behavioral weight loss treatment outcomes. Eat Weight Disord 2015;20:205–13.Web of ScienceCrossrefPubMedGoogle Scholar

  • 38.

    Maximova K, Ambler KA, Rudko JN, Chui N, Ball GDC. Ready, set, go! Motivation and lifestyle habits in parents of children referred for obesity management. Pediatr Obes 2014; DOI: 10.1111/ijpo.272 [Epub ahead of print].PubMedGoogle Scholar

  • 39.

    Hall WJ, Schneider M, Thompson D, Volpe SL, Steckler A, et al. School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes. Trans Behav Med 2014;4:131–40.CrossrefGoogle Scholar

  • 40.

    Ward DS, Saunders R, Felton GM, Williams E, Epping JN, et al. Implementation of a school environment intervention to increase physical activity in high school girls. Health Educ Res 2006;21:896–910.CrossrefPubMedGoogle Scholar

  • 41.

    Gittelsohn J, Merkle S, Story M, Stone EJ, Steckler A, et al. School climate and implementation of the Pathways study. Prev Med 2003;37:S97–106.CrossrefPubMedGoogle Scholar

  • 42.

    Goran MI, Reynolds K, Lindroos AK. Role of physical activity in the prevention of obesity in children. Int J Obes 1999;23:s18–33.CrossrefGoogle Scholar

  • 43.

    Kann L, Brener ND, Allensworth DD. Health education: results from the School Health Policies and Programs Study 2000. J Sch Health 2001;71:266–78.PubMedCrossrefGoogle Scholar

  • 44.

    Gibson CA, Smith BK, DuBose KD, Greene JL, Bailey BW, et al. Physical activity across the curriculum: year one process evaluation results. Int J Behav Nutr Phys Act 2008;5:1–11.Web of ScienceGoogle Scholar

  • 45.

    Donnelly JE, Greene JL, Gibson CA, Smith BK, Washburn RA, et al. Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Prev Med 2009;49:336–41.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 46.

    Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011;12:CD001871.Web of ScienceGoogle Scholar

About the article

Corresponding author: Sihem Ben Fredj, Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia, E-mail: sihem-benfredj@hotmail.com


Received: 2015-04-22

Accepted: 2015-07-02

Published Online: 2015-09-11

Published in Print: 2017-04-01


Citation Information: International Journal of Adolescent Medicine and Health, Volume 29, Issue 2, 20150035, ISSN (Online) 2191-0278, ISSN (Print) 0334-0139, DOI: https://doi.org/10.1515/ijamh-2015-0035.

Export Citation

©2015 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Sonja Klingberg, Catherine Draper, Lisa Micklesfield, Sara Benjamin-Neelon, and Esther van Sluijs
International Journal of Environmental Research and Public Health, 2019, Volume 16, Number 7, Page 1212

Comments (0)

Please log in or register to comment.
Log in