title: Overweight and obesity prevention for adolescents: a cluster randomized controlled trial in a school setting.
abstract: BACKGROUND
  Given the increasing prevalence of obesity among youth over the past decade, prevention has become an international public health priority.
  
  
  OBJECTIVE
  To evaluate the 2-year effectiveness of three strategies aimed at preventing overweight and obesity among adolescents in a high school setting.
  
  
  METHODS
  PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) is a school-based RCT. Each study high school was assigned to receive or not, over a 2-year period (Grades 10 and 11), each of three prevention strategies according to a 2 × 2 × 2 factorial school randomization. Data were collected in 2006-2009 and analyzed in 2009-2011.
  
  
  METHODS
  A total of 3538 adolescents (aged 15.6±0.7 years at baseline) in 24 public high schools in Lorraine (northeastern France) completed the PRALIMAP trial.
  
  
  METHODS
  The prevention strategies were education (development of nutritional knowledge and skills); environment (creation of a favorable environment by improving availability of "healthy" dietary items and physical activity); and screening and care (detection of overweight/obesity and, if necessary, adapted care management).
  
  
  METHODS
  The main outcome of interest was BMI; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes.
  
  
  RESULTS
  Adolescents who completed the PRALIMAP trial were younger, less often suspected of having eating disorders and depression, and came from a higher socioeconomic class than those who did not. The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones: a 0.11 lower increase in BMI (p=0.0303); a 0.04 greater decrease in BMI z-score (p=0.0173); and a 1.71% greater decrease in overweight/obesity prevalence (p=0.0386). Education and environment strategies were not more effective than no strategy intervention.
  
  
  CONCLUSIONS
  Although the screening and care strategy is an effective way to prevent, at 2 years, overweight and obesity among adolescents in a high school setting, its effects over and above no strategy intervention were small.
  
  
  BACKGROUND
  This study is registered at www.clinicaltrials.govNCT00814554.
authors.affiliation: Laboratoire EA4360, University of Lorraine, Apemac, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bonsergent
authors.forename: Nelly
authors.initials: N
authors.lastname: Agrinier
authors.forename: Nathalie
authors.initials: N
authors.lastname: Thilly
authors.forename: Sabrina
authors.initials: S
authors.lastname: Tessier
authors.forename: Karine
authors.initials: K
authors.lastname: Legrand
authors.forename: Edith
authors.initials: E
authors.lastname: Lecomte
authors.forename: Evelyne
authors.initials: E
authors.lastname: Aptel
authors.forename: Serge
authors.initials: S
authors.lastname: Hercberg
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Collin
authors.forename: Serge
authors.initials: S
authors.lastname: Briançon
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D016000:Cluster Analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D012572:School Health Services; D012959:Socioeconomic Factors