UGA, Shanghai researchers find evidence of how obesity programs can work long-term

Childhood obesity is now a global epidemic, and researchers worldwide are searching for sustainable interventions that may halt its progress.

Now, a team of researchers from Fudan University in Shanghai, China, and the University of Georgia have shown that one comprehensive obesity intervention, which integrates family and school participation to encourage healthy eating and exercise habits, can reduce rates of obesity long-term.

The researchers assessed changes to the children’s body mass index one, two and three years following the conclusion of the three-year intervention program.

The initial intervention was based in Shanghai where childhood obesity prevalence ranges between 10 and 15 percent, says Donglan Zhang, one of the study’s authors.

“If you look at childhood obesity problems in China’s megacities, it’s comparable to the U.S.,” said Zhang, who studies health policy at UGA’s College of Public Health.

“This is due to economic development and due to a transition in dietary behaviors. There is a Westernization of food and eating behaviors in China’s big cities.”

The intervention sought to introduce healthy eating behaviors at an early age when habits begin to form.

Like many obesity programs, the intervention began at school. It introduced nutrition education into the classroom, revamped the lunchroom options and established regular exercise for students. The innovation of the program lies with what happened once the students returned home. Acknowledging the role of the home environment, the intervention also trained the students’ parents to support healthy eating habits and exercise outside of school.

The comprehensive nature of the intervention is unique, says Zhang.

“This model in particular recognizes that reducing the obesity rate is not just the responsibility of one institution or environment,” she said. “It should be a joint effort from schools, from families, from communities all together because kids have a lot of [food] environments they’re exposed to.”

In all, almost 1,000 first-grade boys and girls participated in the program. At the end of three years, the program succeeded in helping overweight or obese children lose weight, and it helped children with a healthy weight maintain it.

This is where the story ends for most childhood obesity intervention studies, says Janani Thapa, also with UGA’s College of Public Health. Thapa specializes in childhood obesity interventions and policy.

“What we see in most interventions is a checkmark pattern. The weight tends to decline, and then after the project period ends, we’ll see the weight go back up,” she said.

But that’s not what happened in the three years following the Shanghai intervention.

At each follow-up, the students who participated in the program continued to maintain a healthy BMI compared with students who were not part of the intervention. The effect was even more prominent among girls.

“The current study suggests that it probably requires a minimum of two years to demonstrate a lasting effect,” said Thapa.

Though this work describes the success of an intervention in one setting, the authors say the evidence is strong enough to suggest it could be translated to other settings like the U.S.

“There is the nutrition intervention, there is the physical activity intervention, there are few that have done both,” Thapa pointed out. “The next step would be to try to do the FIS model here in the U.S., and maybe others are trying to do it across the world.”

The study, “A cohort study assessing the sustainable long-term effectiveness of a childhood-obesity intervention in China,” published in the latest International Journal of Epidemiology. It is available online here.

Co-authors include Zhijuan Cao, Jing Hua and Shumei Wang.

– Lauren Baggett

Posted on November 26, 2018.