School-based health-promoting interventions are increasingly seen as an
effective population strategy to improve health and prevent obesity. Evidence on the
long-term effectiveness of school-based interventions is scarce. This study investigates
the four-year effectiveness of the school-based Healthy Primary School of the Future
(HPSF) intervention on children’s body mass index z-score (BMIz), and on the
secondary outcomes waist circumference (WC), dietary and physical activity (PA)
behaviours.
This study has a quasi-experimental design with four intervention schools, i.e., two full HPSFs (focus: diet and PA), two partial HPSFs (focus: PA), and four control schools. Primary school children (aged 4-12 years) attending the eight participating schools were invited to enrol in the study between 2015 and 2019. Annual measurements consisted of children’s anthropometry (weight, height and waist circumference), dietary behaviours (child- and parent-reported questionnaires) and PA levels (accelerometers). Between 2015 and 2019, 2236 children enrolled. The average exposure to the school condition was 2·66 (SD 1·33) years, and 900 participants were exposed for the full four years (40·3%). After four years of intervention, both full (estimated intervention effect (B)=-0·17 (95%CI -0·27 to - 0·08) p=0·000) and partial HPSF (B=-0·16 (95%CI-0·25 to -0·06) p=0·001) resulted in significant changes in children’s BMIz compared to control schools. Likewise, WC changed in favour of both full and partial HPSFs. In full HPSFs, almost all dietary behaviours changed significantly in the short term. In the long term, only consumption of water and dairy remained significant compared to control schools. In both partial and full HPSFs, changes in PA behaviours were mostly absent.
This school-based health-promoting intervention is effective in bringing unfavourable changes in body composition to a halt in both the short and long term. It provides policy makers with robust evidence to sustainably implement these interventions in school-based routine.
IBM SPSS Statistics for Windows, 25.0
