In the struggle against widespread obesity that begins in early childhood, new research indicates that schools may be the best place to start a solution.
Australian researchers examined 55 interventions in previous studies and concluded that school-based programs were key in getting kids to healthy weights, and there was little evidence that these programs would have a negative effect on young students' self-images.
"Obesity prevention programs in general are not harming children," said lead author Elizabeth Waters, chair of child public health at the Melbourne School of Population Health. However, "programs that don't make a commitment to preventing body image issues might hurt children by stigmatizing overweight children or send unhealthy messages about body image," she said.
"We looked for information about harms in our review and, while many studies did not report this information, of those that did, there was no evidence of harm with these programs," Waters said.
The study is published online today (Dec. 6) in the Cochrane Library, a journal that publishes studies compiled by evaluating previous research in the field.
Lessons for weight loss
In developing programs for schools, Waters said that adding lessons on healthy eating, physical activity and body image to the curriculum, along with improving school lunches, making students more active during the day and supporting parents to make similar changes at home would improve children's health.
But while programs in schools may appear successful, there is less evidence, and a need for a greater focus, on children not yet in school, according to the study.
"The strongest evidence of effect is in the 0 to 5 year age group, but the majority of studies were conducted with children 6 to 12 years. So interventions implemented in the early years are effective, and need to be a priority in order to have the greatest impact," Waters said.
While older children benefit from in-school programs, weight-loss efforts may be more effective if they come earlier — in preschools, for example.
"There is a gap in the research in programs for young children," said Dr. Lloyd Werk, chief of the division of general pediatrics at Nemours Children's Hospital, and director of the Healthy Choices Clinic, a weight management program there.
"Perhaps we can work on helping young children grow with habits for their life," Werk said.
Funding needed for some interventions
The study may provide evidence for the effectiveness of weight interventions, but in the U.S., there will be some challenges that come down to funding, Werk said.
Two tactics that are not commonly done in the U.S. were recommended in the report, Werk said, are improving physical activity in schools and spending more money to provide healthier school lunches.
And a third factor, he said, is just as crucial.
"Research to date has focused primarily on interventions that can be delivered through the school or after-school programs," Werk said. But more funding may be needed to support parents at home.
For example, it's difficult, he said, to get patients dietician counseling because of a lack of insurance reimbursement.
"Both public and private insurance tend not to cover nutritional services," Werk said. It is not an issue mentioned in the report, he said, "but one we certainly need to address."
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