|Baranowski, Tom - Children'S Nutrition Research Center (CNRC)|
Submitted to: American Journal of Clinical Nutrition
Publication Type: Review Article
Publication Acceptance Date: 6/25/2012
Publication Date: 8/1/2012
Citation: Baranowski, T. 2012. School-based obesity-prevention interventions in low- and middle-income countries: Do they really work? American Journal of Clinical Nutrition. 96(2):227-228.
Technical Abstract: Obesity is the most common nutrition-related health problem around the world, especially among children. Hundreds of studies have been conducted to test approaches to prevent obesity, and many were in children in schools. Most of these studies were conducted in higher-income countries. An article in this issue of the Journal by Verstraeten et al. (Am J Clin Nutr 2012;96(2):415-438) is the first to review these interventions in low- and middle-income countries. It was reassuring that some evidence indicated that the obesity prevention interventions attained some desired effects in low- to middle-income countries, suggesting these investigators were pursuing important leads, and the effects documented in high-income countries are not circumscribed by their socioeconomic conditions. This review, however, also documented the same diversity in conceptual foundations, intervention procedures, and measures of mediators, behavior, and outcomes, and found small sample sizes: there were few schools (a clustering unit) and few students. High within-cluster similarity of students shrinks the effective sample from the number of students to the number of schools. Not correcting for the clustering can lead to a misrepresentation of outcomes (usually thinking an effect was significant, when it was not). This systematic review of obesity-prevention intervention programs in low- to middle-income countries focuses attention on this issue of growing importance. The findings provide hope that answers can be found. Much research remains to find documented effective solutions for large numbers of children throughout the world.