Effectiveness of a Randomized Controlled Lifestyle Intervention to Prevent Obesity among Chinese Primary School Students: CLICK-Obesity Study.
BACKGROUND
Childhood obesity has been increasing rapidly worldwide. There is limited evidence for effective lifestyle interventions to prevent childhood obesity worldwide, especially in developing countries like China. The objective of this study was to assess the effectiveness of a school-based multi-component lifestyle childhood obesity prevention program (the CLICK-Obesity study) in Mainland China.


METHODS
A cluster randomized controlled trial was developed among grade 4 students from 8 urban primary schools (638 students in intervention, 544 as control) in Nanjing City, China. Students were randomly allocated to the control or intervention group at school-level. A one-year multi-component intervention program (classroom curriculum, school environment support, family involvement and fun programs/events) together with routine health education was provided to the intervention group, while the control group received routine health education only. The main outcome variables assessed were changes in body mass index, obesity occurrence, obesity-related lifestyle behaviors and knowledge.


RESULTS
Overall, 1108 (93.7%) of the 1182 enrolled students completed the intervention study. The intervention group had a larger marginal reduction than did the control group in overall mean BMI value (-0.32±1.36 vs. -0.29±1.40, p = 0.09), although this was not significant. Compared with the control group, the intervention group was more likely to decrease their BMI (OR = 1.44, 95%CI = 1.10, 1.87) by 0.5 kg/m2 or above, increase the frequency of jogging/running (OR = 1.55, 95%CI = 1.18, 2.02), decrease the frequency of TV/computer use (OR = 1.41, 95%CI = 1.09, 1.84) and of red meat consumption (OR = 1.50, 95%CI = 1.15, 1.95), change commuting mode to/from school from sedentary to active mode (OR = 2.24, 95%CI = 1.47, 3.40), and be aware of the harm of selected obesity risk factors.


CONCLUSIONS
The school-based lifestyle intervention program was practical and effective in improving health behaviors and obesity-related knowledge for children in China. This study provides important policy implications on school-based intervention programs for modifications of obesity-related lifestyles.


BACKGROUND
Chinese Clinical Trial Registry ChiCTR-ERC-11001819.
Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China; Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
Fei
F
Xu
School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
Robert S
RS
Ware
School of Health Sciences, Flinders University, Adelaide, South Australia, Australia.
Eva
E
Leslie
School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Lap Ah
LA
Tse
Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
Zhiyong
Z
Wang
Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
Jiequan
J
Li
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, United States of America.
Youfa
Y
Wang
D001364:Awareness; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D018479:Early Intervention, Educational; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D063766:Pediatric Obesity / Q000453:epidemiology* / Q000517:prevention & control*; D012307:Risk Factors; D012574:Schools; D013334:Students