title: Prevention of overweight in preschool children: results of kindergarten-based interventions.
abstract: OBJECTIVE
  Given the increasing prevalence of pediatric obesity, we evaluated two kindergarten-based strategies for reducing overweight in preschool children in the Haute-Garonne Department in France.
  
  
  METHODS
  Kindergartens (n=79) were randomly assigned to one of the two strategies and followed for 2 years. In the first group (Epidémiologie et prévention de l'obésité infantile, EPIPOI-1), parents and teachers received basic information on overweight and health, and children underwent screening to identify those with overweight (body mass index (BMI) > or = 90th percentile) or at risk for overweight (BMI between 75 and 90th percentile), who were then followed up by their physicians. EPIPOI-2 children, in addition, received kindergarten-based education to promote healthy practices related to nutrition, physical activity and sedentary behaviors. Data on control children from non-intervention kindergartens (n=40) were retrieved from medical records at the Division of School Health.
  
  
  RESULTS
  At baseline, groups differed significantly on age and school area (underprivileged/not). Owing to a significant interaction between school area and group, analyses were stratified by school area. At baseline, groups did not differ on overweight prevalence and BMI z-scores for any school area. After intervention, prevalence of overweight, BMI z-score and change in BMI z-score were significantly lower in intervention groups compared with controls in underprivileged areas. Using multilevel analysis adjusted for potential confounders, a significant effect on overweight prevalence at the end of the study was noted for EPIPOI-1 in underprivileged areas only (odds ratio and 95% confidence interval: 0.18 (0.07-0.51). In non-underprivileged areas, the gain in BMI z-score was lower in EPIPOI-2 group compared with control and EPIPOI-1.
  
  
  CONCLUSIONS
  Our results suggest that simple measures involving increasing awareness on overweight and health, and periodic monitoring of weight and height with follow-up care when indicated, could be useful to reduce overweight in young children from underprivileged areas. A reinforced strategy with an education component, in addition, may be indicated in children in non-underprivileged areas.
authors.affiliation: Department of Pediatrics, Children's Hospital, CHU-Toulouse, Toulouse, France. jouret.b@chu-toulouse.fr
authors.forename: B
authors.initials: B
authors.lastname: Jouret
authors.forename: N
authors.initials: N
authors.lastname: Ahluwalia
authors.forename: M
authors.initials: M
authors.lastname: Dupuy
authors.forename: C
authors.initials: C
authors.lastname: Cristini
authors.forename: L
authors.initials: L
authors.lastname: Nègre-Pages
authors.forename: H
authors.initials: H
authors.lastname: Grandjean
authors.forename: M
authors.initials: M
authors.lastname: Tauber
mesh_terms: D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control*; D010290:Parents / Q000193:education*; D012307:Risk Factors; D012572:School Health Services; D012959:Socioeconomic Factors