Overweight and Obesity Prevention for Adolescents: A Cluster Randomized Controlled Trial in a School Setting

• Published in: American journal of preventive medicine 2013, Vol.44 (1), p.30-39
• Main Authors: BONSERGENT, Emilie, AGRINIER, Nelly, THILLY, Nathalie, TESSIER, Sabrina, LEGRAND, Karine, LECOMTE, Edith, APTEL, Evelyne, HERCBERG, Serge, COLLIN, Jean-François, BRIANCON, Serge
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Age Factors; Biological and medical sciences; Body Mass Index; Cluster Analysis; Female; France - epidemiology; Health Education - methods; Health Knowledge, Attitudes, Practice; High schools; Humans; Interventions; Male; Medical sciences; Metabolic diseases; Obesity; Obesity - epidemiology; Obesity - prevention & control; Overweight - epidemiology; Overweight - prevention & control; Prevalence; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; School Health Services; Socioeconomic Factors
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2012.09.055

Given the increasing prevalence of obesity among youth over the past decade, prevention has become an international public health priority. To evaluate the 2-year effectiveness of three strategies aimed at preventing overweight and obesity among adolescents in a high school setting. PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) is a school-based RCT. Each study high school was assigned to receive or not, over a 2-year period (Grades 10 and 11), each of three prevention strategies according to a 2 × 2 × 2 factorial school randomization. Data were collected in 2006-2009 and analyzed in 2009-2011. A total of 3538 adolescents (aged 15.6±0.7 years at baseline) in 24 public high schools in Lorraine (northeastern France) completed the PRALIMAP trial. The prevention strategies were education (development of nutritional knowledge and skills); environment (creation of a favorable environment by improving availability of "healthy" dietary items and physical activity); and screening and care (detection of overweight/obesity and, if necessary, adapted care management). The main outcome of interest was BMI; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes. Adolescents who completed the PRALIMAP trial were younger, less often suspected of having eating disorders and depression, and came from a higher socioeconomic class than those who did not. The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones: a 0.11 lower increase in BMI (p=0.0303); a 0.04 greater decrease in BMI z-score (p=0.0173); and a 1.71% greater decrease in overweight/obesity prevalence (p=0.0386). Education and environment strategies were not more effective than no strategy intervention. Although the screening and care strategy is an effective way to prevent, at 2 years, overweight and obesity among adolescents in a high school setting, its effects over and above no strategy intervention were small. This study is registered at www.clinicaltrials.govNCT00814554.