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Effectiveness of school–home intervention for adolescent obesity prevention: parallel school randomised study

  • Michele R. Sgambato (a1), Diana B. Cunha (a1), Bárbara S. N. Souza (a2), Viviana T. Henriques (a1), Renata R. M. Rodrigues (a1), Ana L. V. Rêgo (a3), Rosangela A. Pereira (a3), Edna M. Yokoo (a2) and Rosely Sichieri (a1)...


Many school-based interventions for obesity prevention have been proposed with positive changes in behaviour, but with unsatisfactory results on weight change. The objective was to verify the effectiveness of a combined school- and home-based obesity prevention programme on excessive weight gain in adolescents. Teachers delivered the school-based primary prevention programme to fifth- and sixth-graders (nine schools, forty-eight control classes, forty-nine intervention classes), which included encouraging healthy eating habits and physical activity. A subgroup of overweight or obese adolescents also received a home-based secondary prevention programme delivered by community health professionals. Schools were randomised to intervention or control group. Intent-to-treat analysis used mixed models for repeated continuous measures and considered the cluster effect. The main outcomes were changes in BMI and percentage body fat (%body fat) after one school-year of intervention and follow-up. Against our hypothesis, BMI increased more in the intervention group than in the control group (Δ = 0·3 kg/m2; P = 0·05) with a greater decrease in %body fat among boys (Δ = –0·6 %; P = 0·03) in the control group. The intervention group increased physical activity by 12·5 min per week compared with the control group. Female adolescents in the intervention group ate healthier items more frequently than in the control group. The subgroup that received both the school and home interventions had an increase in %body fat than in the control group (Δ = 0·89 %; P = 0·01). In the present study, a behavioural change led to a small increase in physical activity and healthy eating habits but also to an overall increase in food intake.


Corresponding author

*Corresponding author: Michele R. Sgambato, email


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1.World Health Organization (2017) Obesity and Overweight. Geneva: WHO. (accessed January 2018).
2.Bloch, KV, Klein, CH, Szklo, M, et al. (2016) ERICA: prevalence of hypertension and obesity in Brazilian adolescents. Rev Saúde Pública 50, Suppl. 1, 9s.
3.Souza, AM, Pereira, RA, Yokoo, EM, et al. (2013). Most consumed foods in Brazil: Nacional Dietary Survey 2008-2009. Rev Saúde Pública 47, Suppl. 1, 190S199S.
4.Wang, Y, Cai, L, Wu, Y, et al. (2015) What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev 16, 547565.
5.Rahman, AA, Jomaa, L, Kahale, LA, et al. (2018) Effectiveness of behavioral interventions to reduce the intake of sugar-sweetened beverages in children and adolescents: a systematic review and meta-analysis. Nutr Rev 76, 88107.
6.Sobol-Goldberg, S, Rabinowitz, J & Gross, R (2013) School-based obesity prevention programs: a meta-analysis of randomized controlled trials. Obesity (Silver Spring) 21, 24222428.
7.Okely, AD & Hammersley, ML (2018) School–home partnerships: the missing piece in obesity prevention? Lancet Child Adolesc Health 2, 56.
8.Kong, K, Liu, J & Tao, Y (2016) Limitations of studies on school-based nutrition education interventions for obesity in China: a systematic review and meta-analysis. Asia Pac J Clin Nutr 25, 589601.
9.Sichieri, R & Cunha, DB (2014) Unbalanced baseline in school-based interventions to prevent obesity: adjustment can lead to bias – a systematic review. Obesity Facts 7, 221232.
10.Verstraeten, R, Roberfroid, D, Lachat, C, et al. (2012) Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review. Am J Clin Nutr 96, 415438.
11.Rodrigues, LBB, Silva, PCS, Peruhype, RC, et al. (2014) A Atenção Primária à Saúde na coordenação das redes de atenção: uma revisão integrativa (Primary Health Care in the coordination of care networks: an integrative review). Ciênc Saúde Colet 19, 343352.
12.Instituto Brasileiro de Geografia e Estatística (2010) População (Population). Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística. (accessed June 2018).
13.Loudon, K, Treweek, S, Sullivan, F, et al. (2015) The PRECIS-2 tool: designing trials that are fit for purpose. BMJ 350, h2147.
14.BRASIL. Ministério da Saúde (2012) Política Nacional de Atenção Básica. Brasília: Ministério da Saúde (Série E. Legislação em Saúde). (accessed November 2018).
15.Sichieri, R, Trotte, A, Souza, RA, et al. (2009) School randomized trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr 12, 197202.
16.Sgambato, MR, Cunha, DB, Henriques, VT, et al. (2016) PAAPPAS community trial protocol: a randomized study of obesity prevention for adolescents combining school with household intervention. BMC Public Health 16, 809.
17.Gordon, CC, Chumlea, WC & Roche, AF (1988) Stature, recumbent length, and weight. In Anthropometric Standardization Reference Manual, pp. 38 [Gordon, CC, Chumlea, WC and Roche, AF, editors]. Champaign, IL: Human Kinetics Books. Onis, M, Onyango, AW, Borghi, E, et al. (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85, 660667.
19.Araujo, MC, Yokoo, EM & Pereira, RA (2010) Validation and calibration of a semiquantitative food frequency questionnaire designed for adolescents. J Am Diet Assoc 110, 11701177.
20.Barufaldi, LA, Abreu, GA, Veiga, GV, et al. (2016) Software to record 24-hour food recall: application in the Study of Cardiovascular Risks in Adolescents. Rev Bras Epidemiol 19, 464468.
21.Tavares, LF, Castro, IRR, Cardoso, LO, et al. (2014) Validade de indicadores de atividade física e comportamento sedentário da Pesquisa Nacional de Saúde do Escolar entre adolescentes do Rio de Janeiro, Brasil (Validity of physical activity indicators and sedentary behaviour of the National School Health Survey among adolescents from Rio de Janeiro, Brazil). Cad Saúde Pública 30, 18611874.
22.Boutron, I, Altman, DG, Moher, D, et al. (2017) CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Annals of internal medicine. Am Coll Physicians 167, 40.
23.Singer, JD & Willett, JB (2003) Applied Longitudinal Data Analysis – Modeling Change and Event Occurrence. New York: Oxford University Press.
24.Klesges, RC, Obarzanek, E, Kumanyika, S, et al. (2010) The Memphis Girls’ health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls. Arch Pediatr Adolesc Med 164, 10071114.
25.Rosenkranz, RR, Behrens, TK & Dzewaltowski, DA (2010) A group-randomized controlled trial for health promotion in Girl Scouts: healthier troops in a SNAP (Scouting Nutrition & Activity Program). BMC Public Health 10, 81.
26.Ezendam, NP, Brug, J & Oenema, A (2012) Evaluation of the Web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. Arch Pediatr Adolesc Med 166, 248255.
27.Cunha, DB, Souza, BSN, Pereira, RA, et al. (2013) Effectiveness of a randomized school-based intervention involving families and teachers to prevent excessive weight gain among adolescents in Brazil. PLOS ONE 8, e57498.
28.Louzada, MLC, Martins, APB, Canella, DS, et al. (2015) Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saúde Pública 49, 38.
29.Ledoux, TA, Hingle, MD & Baranowski, T (2011) Relationship of fruit and vegetable intake with adiposity: a systematic review. Obes Rev 12, e143e150.
30.Bezerra, IN & Sichieri, R (2011) Household food diversity and nutritional status among adults in Brazil. Int J Behav Nutr Phys Act Mar 27, 822.
31.De Micheli, D, Fisberg, M & Formigoni, MLOS (2004) Estudo da efetividade da intervenção breve para o uso de álcool e outras drogas em adolescentes atendidos num serviço de assistência primária à saúde (Study of the effectiveness of a brief intervention for the use of alcohol and other drugs in adolescents treated at an adolescent primary health care service). Rev Assoc Med Bras 50, 305313.
32.Hebert, JR, Ma, Y, Clemow, L, et al. (1997) Gender difference in social desirability and social approval bias in dietary self-report. Am J Epidemiol 146, 10461055.
33.Moreira, N, Sichieri, R, Reichenheim, ME, et al. (2015) The associations of BMI trajectory and excessive weight gain with demographic and socio-economic factors: the Adolescent Nutritional Assessment Longitudinal Study cohort. Br J Nutr 114, 20322038.
34.Neumark-Sztainer, D, Wall, M, Guo, J, et al. (2006) Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J Am Diet Assoc 106, 559568.
35.Mattes, RD (2018) Evidence on the ‘normalizing’ effect of reducing food-portion sizes. Am J Clin Nutr 107, 501503.
36.Bjerregaard, LG, Jensen, BW, Ängquist, L, et al. (2018) Change in overweight from childhood to early adulthood and risk of type 2 diabetes. N Engl J Med 378, 13021312.
37.Tarabashkina, L, Quester, P & Crouch, R (2016) Food advertising, children’s food choices and obesity: interplay of cognitive defences and product evaluation: an experimental study. Int J Obes (Lond) 40, 581586.


Effectiveness of school–home intervention for adolescent obesity prevention: parallel school randomised study

  • Michele R. Sgambato (a1), Diana B. Cunha (a1), Bárbara S. N. Souza (a2), Viviana T. Henriques (a1), Renata R. M. Rodrigues (a1), Ana L. V. Rêgo (a3), Rosangela A. Pereira (a3), Edna M. Yokoo (a2) and Rosely Sichieri (a1)...


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