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) ⩾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.
Conclusion:
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
World Health Organization. Obesity: preventing and managing the global epidemic. Report on a WHO Consultation 1998. World Health Organization: Geneva, Switzerland, 1998. (Technical Report Series no.894).
Janssen I, Katzmarzyk PT, Boyce WF, Vereecken C, Mulvihill C, Roberts C et al., Health Behaviour in School-Aged Children Obesity Working Group. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev 2005; 6: 123–132.
Bundred P, Kitchiner D, Buchan I . Prevalence of overweight and obese children between 1989 and 1998: population based series of cross sectional studies. BMJ 2001; 322: 326–328.
Reilly JJ . Descriptive epidemiology and health consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab 2005; 19: 327–341.
Must A, Strauss RS . Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999; 23 (Suppl 2): S2–S11.
Lobstein T, Jackson-Leach R . Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease. Int J Pediatr Obes 2006; 1: 33–41.
Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001; 358: 1400–1404.
Baker JL, Olsen LW, Sørensen TI . Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 2007; 357: 2329–2337.
Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH . Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 337: 869–887.
Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ . Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008; 9: 474–488.
Haut Comité de la Santé Publique. Pour une politique nutritionnelle de santé publique en France. Enjeux et propositions. ENSP ed Paris 2000. (http://www.sante.gouv.fr/htm/pointsur/nutrition/sommaire.htm) Retrieved 21 January 2009.
Lissau I . Prevention of overweight in the school arena. Acta Paediatr 2007; 96: 12–18.
Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, Campbell KJ . Interventions for preventing obesity in children. Cochrane Database of Systematic Review 2005. Issue no. 3 Article no. CD001871.
Bluford DA, Sherry B, Scanlon KS . Interventions to prevent or treat obesity in preschool children: a review of evaluated programs. Obesity 2007; 15: 1356–1372.
Reilly JJ, Kelly L, Montgomery C, Williamson A, Fisher A, McColl JH et al. Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ 2006; 333: 1041.
Mo-Suwan L, Pongprapai S, Junjana C, Peutpaiboon A . Effects of a controlled trial of a school-based exercise program on the obesity indexes of preschool children. Am J Clin Nutr 1998; 68: 1006–1011.
Warren JM, Henry CJK, Lightowler HJ, Bradshaw SM, Perwaiz S . Evaluation of a pilot school programme aimed at the prevention of obesity in children. Health Promot Int 2003; 18: 287–296.
Epstein LH, Roemmich JN, Robinson JL, Paluch RA, Winiewicz DD, Fuerch JH et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med 2008; 162: 239–245.
Muller MJ, Asbeck I, Mast M, Lagnaese L, Grund A . Prevention of Obesity—more than an intention. Concept and first results of the Kiel Obesity Prevention Study (KOPS). Int J Obes Relat Metab Disord 2001; 25 (Suppl 1): S66–S74.
Fitzgibbon ML, Stolley MR, Schiffer L, Van Horn L, KauferChristoffel K, Dyer A . Two-year follow-up results for Hip-Hop to Health Jr.: a randomized controlled trial for overweight prevention in preschool minority children. J Pediatr 2005; 146: 618–625.
Dennison BA, Russo TJ, Burdick PA, Jenkins PL . An intervention to reduce television viewing by preschool children. Arch Pediatr Adolesc Med 2004; 158: 170–176.
Wofford LG . Systematic review of childhood obesity prevention. J Pediatr Nurs 2008; 23: 5–19.
Jouret B, Ahluwalia N, Cristini C, Dupuy M, Negre-Pages L, Grandjean H et al. Factors associated with overweight in preschool-age children in southwestern France. Am J Clin Nutr 2007; 85: 1643–1649.
Rolland-Cachera MF, Cole TJ, Sempe M, Tichet J, Rossignol C, Charraud A . Body Mass Index variations: centiles from birth to 87 years. Eur J Clin Nutr 1991; 45: 13–21.
Plachta-Danielzik S, Pust S, Asbeck I, Czerwinski-Mast M, Langnäse K, Fischer C et al. Four-year follow-up of school-based intervention on overweight children: the KOPS study. Obesity 2007; 15: 3159–3169.
Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J et al. A policy-based school intervention to prevent overweight and obesity. Pediatrics 2008; 121: 794–802.
Danielzik S, Czerwinski-Mast M, Langnäse K, Dilba B, Müller MJ . Parental overweight, socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5-7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS). Int J Obes Metab Disord 2004; 28: 1494–1502.
Janssen I, Boyce WF, Simpson K, Pickett W . Influence of individual- and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr 2006; 83: 139–145.
Blomquist HK, Bergström E . Obesity in 4-year-old children more prevalent in girls and in municipalities with a low socioeconomic level. Acta Paediatr 2007; 96: 113–116.
Lamerz A, Kuepper-Nybelen J, Wehle C, Bruning N, Trost-Brinkhues G, Brenner H et al. Social class, parental education, and obesity prevalence in a study of six-year-old children in Germany. Int J Obes Relat Metab Disord 2005; 29: 373–380.
Lioret S, Maire B, Volatier JL, Charles MA . Child overweight in France and its relationship with physical activity, sedentary behaviour and socioeconomic status. Eur J Clin Nutr 2007; 61: 509–516.
Parsons TJ, Power C, Logan S, Summerbell CD . Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metab Disord 1999; 23 (Suppl 8): S1–S107.
Pratt CA, Stevens J, Daniels S . Childhood obesity prevention and treatment: recommendations for future research. Am J Prev Med 2008; 35: 249–252.
Acknowledgements
We are indebted to Pierre Machicot and Richard Cosaert, Caisse Primaire d’Assurance Maladie (social security) of Haute-Garonne region for their assistance with subject recruitment. We are thankful to Drs Francoise Collet, Danielle Augier, Danielle Leautier and Claudine Guitard, the Protection Maternelle et Infantile (Division of School Health), and Drs Marie-Françoise Delors, Fanny Delon et Dorothée Querleu (Ministry of Education), Haute-Garonne region, for their assistance in obtaining the information from children's medical records. We are grateful to Dr Nadia Lounis, Johanne Galino and Corinne Fleury for their assistance in data collection. We thank Professor Didier Concordet, Institut National de la Recherche Agronomique (National Institute for Research in Agronomy), for his guidance with multilevel regression analyses. The authors’ contributions were as follows—BJ: overseeing study and writing of the paper; NA: supervision of data analysis, and writing of the paper; MD: contributed to data analysis under the supervision of HG and NA and to the paper development; CC: contributed to data analysis under the supervision of HG and NA and to the paper development; LNP: study coordination and comments on the paper; HG: design of the study, supervision of data analysis and contributing to the paper development; MT: design of study, funding for the study, overseeing study and contributing to the paper development. This work is supported by grants from the French Social Security System.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jouret, B., Ahluwalia, N., Dupuy, M. et al. Prevention of overweight in preschool children: results of kindergarten-based interventions. Int J Obes 33, 1075–1083 (2009). https://doi.org/10.1038/ijo.2009.166
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ijo.2009.166
Keywords
This article is cited by
-
A feasibility cluster randomised controlled trial of a preschool obesity prevention intervention: ToyBox-Scotland
Pilot and Feasibility Studies (2019)
-
Effectiveness of Nutrition Intervention in a Selected Group of Overweight and Obese African-American Preschoolers
Journal of Racial and Ethnic Health Disparities (2018)
-
Using Family Backpacks as a Tool to Involve Families in Teaching Young Children About Healthy Eating
Early Childhood Education Journal (2018)
-
Die Wiener Präventionsstudie EDDY – Erste Ergebnisse
Pädiatrie & Pädologie (2016)
-
Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact
BMC Public Health (2015)