Introduction

Childhood obesity is a serious problem worldwide and represents one of the most urgent health issues facing humanity. There are now around 50 million girls and 74 million boys aged 5 to 19 years who are classified as obese. Sometimes obesity is considered a bigger problem in developed countries, but it’s also on the rise in the developing and third world as high-calorie processed foods become more available.¹ This represents a significant health and financial issue. The disease and its effects burden health systems and affect children into adulthood. The root causes of obesity are complex, but it generally occurs when we eat more calories than we need.²

Being overweight or obese is particularly harmful to children and can lead to severe health problems as they grow older. Children with higher body weight are at a greater risk of developing serious diseases like heart disease, type 2 diabetes, and certain cancers when they grow up. Obesity is a complex disorder and can be incredibly difficult to treat. As such, prevention is seen as more powerful than cure, and this effort should start as early as possible.³

Why is childhood obesity a problem?

Childhood obesity has serious effects on the physical and mental health of children and can lead to conditions like diabetes, heart problems, asthma, and psychological issues that continue throughout childhood. Here are some key points:

• Health risks: obesity in kids can cause diabetes, high blood pressure, liver disease, gallstones, asthma, and even sleep apnea. It also increases the risk of metabolic syndrome, a group of conditions that raise the risk of heart disease.⁴
• Metabolic syndrome: this includes high blood pressure, high blood sugar, and unhealthy cholesterol levels, often seen in obese children.
• Dyslipidemia: obese kids often have high levels of bad fats in their blood, which can lead to heart disease.
• Glucose intolerance and diabetes: obese children are much more likely to develop Type 2 diabetes, which has a range of health implications.
• Hypertension: many obese children have high blood pressure, increasing their risk for heart issues.
• Liver disease: obesity can lead to serious liver problems, including fatty liver disease.
• Cholelithiasis: obese adolescents, especially girls, are at higher risk for gallstones.
• Asthma: overweight children are more likely to have asthma, which can be worsened by obesity.
• Sleep apnea: obesity increases the risk of obstructive sleep apnea, leading to poor sleep and other health issues.
• Orthopaedic issues: obese children are more prone to bone and joint problems.
• Polycystic ovary disease (PCOD): obesity is linked to PCOD in girls, causing hormonal imbalances and other issues.
• Long-term obesity: many obese children remain obese into adulthood, increasing their risk of severe health problems later in life.
• Mental health: obese children often suffer from low self-esteem, depression, and anxiety. They may also face bullying and social isolation.
• Academic impact: health problems related to obesity can cause children to miss school, with noticeable effects on their learning.
• Eating disorders: obese children are at higher risk for developing eating disorders, which can further complicate their health.

School-based interventions for curbing childhood obesity

Because childhood obesity has far-reaching adverse effects on the lives of children, a lot of research has been done to identify methods of preventing or reversing it.⁴ As children spend a significant amount of their time at school, using the school environment to shape eating and exercise behaviour has obvious potential. Here are the key elements that contribute to the success of these interventions:

• Teacher involvement: training teachers to deliver health interventions, coordinate school-based activities, and promote healthy behaviours during school hours has proven more effective than using external personnel. Teachers also enhance the intervention by acting as role models and engaging actively in promoting healthy behaviours.⁵
• School policies: successful school policy changes include increasing water accessibility, providing free fruits, offering only healthy food options in the cafeteria, and removing vending machines. Establishing a wellness council and drafting a written wellness policy also drives the effectiveness of these programs.
• Family involvement: engaging families is crucial. Approaches include family “homework” assignments, newsletters with healthy recipes, and school meetings. These efforts aim to extend healthy behaviours into the home environment and maintain them outside school hours.⁶
• Activity promotion and incentives: promoting physical activity during recess, developing active playgrounds, and ensuring enjoyable, inclusive physical education classes are effective. Offering motivational incentives like stickers or t-shirts and using social marketing techniques like slogans also enhance the impact of interventions.
• Community collaboration: working with community stakeholders and the media supports the implementation and sustainability of health promotion projects focused on physical activity and healthy eating.⁷
• Targeted interventions in vulnerable communities: in areas with low socioeconomic status or vulnerable groups, interventions focus on environmental changes, engaging parents, and interactive activities like cooking and dance classes. Educational content is less emphasised. Some programs, such as those targeting specific cultural groups, may include tailored approaches like gender-separated physical activity classes to increase adherence and effectiveness.⁸

Additional strategies for school-based interventions for curbing obesity in children

• Technology integration: utilising apps and online platforms can promote healthy eating and physical activity. Digital games and tools that encourage movement and track progress can also be very effective.
• Mental health support: addressing the psychological aspects of obesity is essential. Providing counselling services for children dealing with self-esteem and body image issues can support overall well-being and encourage healthier lifestyles.

Measuring success

It is possible to measure the effectiveness of interventions by tracking changes in BMI, physical fitness, and dietary habits. Monitoring and collecting data on these essential metrics can help in assessing the success of the intervention and making adjustments if needed.

Examples of successful school-based interventions

In 2009, a group of researchers in Greece performed a large study of 646 fifth-grade children from 13 schools. The study aimed to improve children’s health by promoting healthy eating and exercise at home and school. The study aimed to improve children’s health by schools providing healthy food options and enjoyable fitness classes and keeping schoolyards open after hours for the children to play in. Parents were encouraged to support their children’s healthy habits through meetings and overcoming barriers to physical activity. Teachers also acted as role models for healthy behaviours. As a result, children ate more fruits and fewer unhealthy foods, and their body mass index improved, showing the effectiveness of these combined efforts.⁶

A study was performed in Chile in 2008 involving 2,430 students from grades 1 to 8 across four schools over two school years. The intervention included training teachers, educating parents through meetings, and providing students with educational and physical education (PE) classes. Additionally, active recess periods were incorporated to encourage more physical activity. As a result, there was a significant reduction in the prevalence of obesity and improvements in BMI among both boys and girls, demonstrating the success of these combined efforts in promoting healthier lifestyles for children.⁹

In 2017, a study took place in the South West of England and involved 1,324 children aged 9 to 10 years from 32 schools over one school year. As part of the study, the scientists developed the Healthy Lifestyles Programme (HeLP), which included dynamic and interactive activities such as physical activity workshops, educational sessions with homework tasks, drama sessions, and goal setting to modify behaviour with parental support. The program also involved extensive stakeholder involvement and intervention mapping. While there were no significant changes in children’s weight or physical activity levels, there were notable improvements in their eating habits. Children ate fewer energy-dense snacks and showed better food choices during the week, indicating some positive dietary changes from the program.¹⁰

Although these represent just a small sample of studies performed to date, they highlight the potential of school-based interventions to significantly improve children’s health.

Conclusion

School programs play a crucial role in preventing childhood obesity, which is becoming a major issue worldwide. Many school-based initiatives have shown great results by using various effective strategies. This shows no single solution to this problem; instead, different approaches can work well. Future programs should build on what has already been successful and consider cultural differences. Tracking the long-term success of these programs will help us understand which strategies work best over time.

More research is needed to understand how long-term programs can be most effective. It’s important to document how these programs are developed and carried out, as well as any challenges or helpful factors. Sharing this information will help the scientific community understand how to successfully implement these programs in real-world settings.