20 cent school intervention stops unhealthy weight gain in children

"Obesity has reached a plateau in developed countries but continues to rise in many developing countries, such as Brazil," said Ms Schneid Schuh. "Thus, it is necessary to develop low-cost methods to prevent people become overweight, starting in childhood."

Healthy School, Happy School was a randomised controlled trial designed to test the effectiveness of an intervention stop obesity in children. It was conducted in Feliz, Brazil.

"Feliz is the Portuguese word for 'Happy', and the study name pays tribute to this small but very special town in South Brazil," said Ms Schneid Schuh. "Mainly influenced by German immigration, Feliz has one of the highest human development indexes in the country.2 But health problems such as obesity, sedentarism, hypertension and other chronic diseases are aggravated by rising urbanisation and changing eating habits."

The research group in paediatric preventive cardiology in Porto Alegre recruited four public schools in Feliz with students of both genders, aged between five and 16 years. Schools were randomly assigned to one of two groups for nine months: the intervention group (two schools with 73 children), which focused on lifestyle changes at school and at home, or the control group (two schools with 140 children), which only received the usual recommendations from the regular school curriculum.

The interventions in the study were delivered by nutritionists in the Research Group on Cardiovascular Prevention in Childhood and Adolescence (PREVINA), nutrition graduate students, and psychologists and nurses employed by Feliz City Hall.

Intervention activities occurred monthly in the schools' multimedia room or sports court, with seminars and workshops about physical activities, healthy eating behaviours and bullying. This last topic was included after talking to children, who reported dissatisfaction with body image and suffering bullying from classmates for being obese. Afterwards, homework activities which required family interaction and commitment to accomplish the goals were proposed. In addition, schools promoted healthy eating by displaying posters and selling nutritious food in the snack bar.

There was no difference between groups before the intervention. The average age was 9 ± 2 years, average body mass index (BMI) was 19 kg/m2 and 55.4% were girls.

The children in the control group showed a significant increase in BMI after the nine months of the study. BMI in the intervention group remained the same, but there was a significant increase in fruit consumption and physical activity (p < 0.05).

Ms Schneid Schuh said: "The implementation cost of the intervention was very low, at less than USD $0.20 per student. This indicates that it could be reproduced in other low resource settings."

She concluded: "This intervention in the school environment was able to stop an increase in BMI. This is an encouraging finding since obesity is rising in Brazil in general, and in Feliz in particular. Most importantly, being able to increase physical activity and fruit consumption in childhood may be crucial for building a healthy and happy life in the long run."