thesis statement in child obesity

Childhood Obesity: Causes/Solutions Research Paper

Thesis statement, introduction, statistics about the problem, causes of childhood obesity, steps the government should take to eliminate the problem, works cited, note card i, note card ii.

Childhood obesity is one of the biggest developing health problems associated with the things such as types of foods that children consume, genetic factors, addiction to highly pleasurable foods, and diminished physical activities.

Therefore, failure of the government to take precautionary measures such as controlling the foods served to children, introduction of BMI checking to schoolchildren, and planning of anti-obesity campaigns amongst others will automatically threaten the health of children and that of the population of the nation at large.

Obesity is the development of more weight than the body of an individual is supposed to carry. Ideally, the body of a person should carry weight within a certain range according to the height of the given individual. Much weight for a specific height is deemed overweight and consequently underweight for a much less weight for a specific height.

Therefore, childhood obesity is the development of more weight, which is mostly fats, more than the height can accommodate. It is usually 20% more body fat weight in a child. Childhood obesity is a serious health problem to society due to the frequency of obesity cases that are being reported of late.

The greatest concern brought about by childhood obesity is that it has been identified as a precursor to certain adulthood ailments if not controlled. Thus, controlling it is a way of eliminating some adulthood ailments. As Riley reveals, childhood obesity leads to such ailments as; “hypertension, respiratory ailments, orthopedic problems, depression, type two diabetes, and high cholesterol among others” (395).

According to Green and Riley, childhood obesity has increased threefold since the year 1981. Sixteen per cent percentage of the population of children between the ages of 6 and 19 years suffer from obesity (917).

In the United States, 23% of children coming from poor families are likely to suffer from obesity compared to 14% of those who come from families that are doing well socially and economically (Riley 395). Obesity has led to a rise in the cost of healthcare for the national government with obesity cases consuming up to 71million dollars in terms of treatment between the years 2008-2009.

According to statistics, there has been a 50% increase in obese cases among children of 7-12 years during the years 1991-1998. Eyler finds that the United States of America government has had to come up with policies and legislation that would reverse the trend by the year 2015 (2294). This effort is an indicator to the seriousness of the problem and the concern that the government has towards it. What causes childhood obesity?

The Foods in the Market

One of the biggest causes of childhood obesity is the type of food a child eats. Following the increase in populations and the decrease in the land for agricultural production, scientists have come up with ways of producing high yields of crops on remarkably small pieces of land for feeding the populations. Most of these foods are produced using biotechnology and bioengineering, which lead to high crop yields. Most crops produced using the methods have been cited as sources of obesity upon producing food from them.

High yield crop production involves altering of the genetic makeup of the crops. When consumed by children and or other people, the effects are directly transferred to them. Animals that used as food to human beings are usually fed on foods with high hormones to spur quick growth of the animals. When children feed on products from these animals, the hormones are directly transferred to them thus triggering a faster development of their cells and body tissues hence leading to obesity.

Genetic Factors

Genetic factors can also be attributed to be a cause of childhood obesity that happens when a child grows bigger than the actual size, and then it is cited as a family trend. Some people are naturally grown. This condition sometimes inherited and passes from one generation to the other.

The study further revealed that there is a 75% chance of children being obese if their parents were obese and a 75% chance of children being thin or slim if their parents were thin. This fact is a sure indicator that obesity is a genetic factor that is passed on from parents to their children. The situation can be controlled if the children engage in activities that can enable them burn the extra calories and fats.

Addiction to highly pleasurable foods

According to Pretlow, addiction to highly pleasurable foods can be one of the biggest causes of obesity in children between the age of 5years to 19years (297). Most of these highly pleasurable foods are extraordinarily high in calories thus leading to extremely fast weight gain in children and young adults.

The advent of fast food outlets has exacerbated the problem because most of the foods sold in fast food outlets are highly pleasurable besides containing excess calories. Addiction to these kinds of foods can be equated to some extent to the addiction found in substances like drugs. Addiction to highly pleasurable foods thus leads the child eating more and more of the food. Because they are not in a position to burn the loads of calories gained by their bodies, they tend to begin piling more and more fats in their bodies.

Diminished physical activities

Childhood obesity can be attributed to diminished physical activities among children. Most children nowadays do not engage in physical activities as compared to the past. In the past, most parents would engage their children in physical activities like doing household chores while going out to play at the same time as a way of engaging in fun. That trend has changed dramatically in the recent past with most children engaging in activities that are not energy sapping.

The trend has changed with the introduction of computer games in society. Most children have ended up becoming couch potatoes because they spend almost all of their playing time playing computer games, which are addictive in nature. The increase in television programs has also led to children getting addicted to watching television. Reilly finds that television companies have come up with tailor-made programs for children thus leading to television addiction (395).

Controlling the food served in schools

The government should come up with a policy guideline on what types of food can be served in school kitchens. Nutritionists should recommend the foods because they have the right calorie contents for children at specific ages.

This campaign will see the government prepare a school feeding diet program that is based on healthy eating habits, which are aimed at reducing obesity and hence eliminating it in the end. An observation by Wojcicki and Heyman contends that an awareness program starting from schools is a sure way of controlling obesity (1630).

Introduction of BMI check in schools

The government should introduce a regular body mass index check to all children in schools as a way of checking and regulating the problem. A regular body mass index check will make the children aware of their weight status and the need to keep healthy bodies and lifestyles.

Such checks can also be used for recommending specific physical activity programs to the children as a way of enabling them burn the excess fats that have accumulated in their bodies. Children growing up with the awareness of the right body mass index will be able to control overweight problems when they occur in the future thus ensuring a healthy nation.

Develop a nationwide anti obesity campaign

The government should develop a nationwide campaign that will see the awareness levels of the population increased to such an extent that everyone in society is aware of the problem. Huang observes that a nationwide campaign to eliminate obesity will enable parents bring up their children with awareness of the obesity problem (148).

Most parents are usually unaware of the obesity problem in their children thus ending up not taking the right steps to stop it. The society today is made up of parents who spend a lot of their time chasing their careers than taking care of their children and hence the need to remind them of their responsibility.

Childhood obesity is a complex problem that cannot be easily wished away due to the many different elements that cause to it. It needs a multipronged approach that will control it. The problem with obesity is that it cannot be eliminated. Thus, there is a need for the government to put measures as discussed above to minimize it as much as possible.

Eyler, Army et al. “Patterns and predictions of state childhood obesity legislation in United States: 2006-2009.” American Journal of Public health 102.12 (2012): 2294- 2302. Print.

Green, Gregory, and Riley Clarence. “Physical activity and childhood obesity: Strategies and solutions for schools and parents.” Education 132.4 (2012): 915-920. Print.

Huang, Terry. “Prevention and treatment: Solutions beyond the individual.” Journal of Law, Medicine & Ethics 35 (2007): 148-149. Print.

Pretlow, Robert. Addiction to highly pleasurable food as a cause of the childhood obesity epidemic: A qualitative internet study . Washington D.C: Routledge, 2008. Print.

Riley, John. “Childhood obesity: An overview.” Children & Society 21.5 (2007): 390-396. Print.

Wojcicki, Janet, and Melvin Heyman. “Reducing childhood obesity by eliminating 100% fruit juice.” American Journal of Public Health 102.9 (2012): 1630-1633. Print.

Summary Note Card:

Following the rising impacts that obesity has had on the US citizens, leave alone the children, there has been a call to the government to pass bills that emphasize the need to reduce the danger caused by this fatal disease. Patterns and Predictors of Enactment of State Childhood Obesity Legislation in the United States: 2006-2009 points out the efforts that the US is making to curb the rising trend by 2015. The article reveals how the US has made it a priority to pass bills that address needs of the obese people as a way of ensuring that they are not left to die of the disease when measures can actually be implemented to rescue them and the US at large.

Quotation Note Card:

Eyler et al state, “…the number of bills introduced from 2006 to 2009 with obesity prevention content is encouraging, as is the enactment rate of these bills.”

Eyler, Army et al. “Patterns and predictions of state childhood obesity legislation in United States: 2006-2009.” American Journal of Public health 102.12 (2012): 2298. Print.

Paraphrase Note Card:

According to Eyler et al, the period 2006-2008 has been characterized by tremendous efforts by the US government to publish many bills that specifically touch on the issue of obesity. The findings indicate that the earlier on observed obesity trend in the US will be changing with time with fewer reports of obesity cases.

Despite the many efforts put in place to fight obesity, it is alarming to find out how obesity prevalence is rising in the UK and the US specifically among children and adolescents.

This revelation indicates that the current strategies used to fight the disease do not have a well-crafted message to persuade the children and adolescents to change their eating habits and or engage in strenuous activities to help rid themselves of the many useless calories whose accumulation has led to their obese nature. Hence, there is room for more studies on the best strategies to use to reach the affected children and adolescent if at all eliminating obesity is the goal of both the UK and the US.

“Successful prevention of obesity in future will require good examples or models of interventions which have achieved objectively measured and sustained behavior change”

Riley, John. “Childhood obesity: An overview.” Children & Society 21.5 (2007): 395. Print.

Due to the observed failure of the current strategies to help the obese children and adolescents, there has been a call for future research to incorporate interventions that will have the capacity to alter the observed high rates of obesity among the US and the UK children and adolescents.

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IvyPanda. (2023, November 26). Childhood Obesity: Causes/Solutions. https://ivypanda.com/essays/childhood-obesity-causes-solutions/

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Bibliography

IvyPanda . "Childhood Obesity: Causes/Solutions." November 26, 2023. https://ivypanda.com/essays/childhood-obesity-causes-solutions/.

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How To Write A Strong Obesity Research Paper?

Table of Contents

Obesity is such a disease when the percent of body fat has negative effects on a person’s health. The topic is very serious as obesity poisons the lives of many teens, adults and even children around the whole world.

Can you imagine that according to WHO (World Health Organization) there were 650 million obese adults and 13% of all 18-year-olds were also obese in 2016? And scientists claim that the number of them is continually growing.

There are many reasons behind the problem, but no matter what they are, lots of people suffer from the wide spectrum of consequences of obesity.

Basic guidelines on obesity research paper

Writing any research paper requires sticking to an open-and-shut structure. It has three basic parts: Introduction, Main Body, and Conclusion.

According to the general rules, you start with the introduction where you provide your reader with some background information and give brief definitions of terms used in the text. Next goes the thesis of your paper.

The thesis is the main idea of all the research you’ve done written in a precise and simple manner, usually in one sentence.

The main body is where you present the statements and ideas which disclose the topic of your research.

In conclusion, you sum up all the text and make a derivation.

How to write an obesity thesis statement?

As I’ve already noted, the thesis is the main idea of your work. What is your position? What do you think about the issue? What is that you want to prove in your essay?

Answer one of those questions briefly and precisely.

Here are some examples of how to write a thesis statement for an obesity research paper:

• The main cause of obesity is determined to be surfeit and unhealthy diet.
• Obesity can be prevented no matter what genetic penchants are.
• Except for being a problem itself, obesity may result in diabetes, cancers, cardiovascular diseases, and many others.
• Obesity is a result of fast-growing civilization development.
• Not only do obese people have health issues but also they have troubles when it comes to socialization.

20 top-notch obesity research paper topics

Since the problem of obesity is very multifaceted and has a lot of aspects to discover, you have to define a topic you want to cover in your essay.

How about writing a fast food and obesity research paper or composing a topic in a sphere of fast food? Those issues gain more and more popularity nowadays.

A couple of other decent ideas at your service.

• The consequences of obesity.
• Obesity as a mental problem.
• Obesity and social standards: the problem of proper self-fulfilment.
• Overweight vs obesity: the use of BMI (Body Mass Index).
• The problem of obesity in your country.
• Methods of prevention the obesity.
• Is lack of self-control a principal factor of becoming obese?
• The least obvious reasons for obesity.
• Obesity: the history of the disease.
• The effect of mass media in augmentation of the obesity level.
• The connection between depression and obesity.
• The societal stigma of obese people.
• The role of legislation in reducing the level of obesity.
• Obesity and cultural aspect.
• Who has the biggest part of the responsibility for obesity: persons themselves, local authorities, government, mass media or somebody else?
• Why are obesity rates constantly growing?
• Who is more prone to obesity, men or women? Why?
• Correlation between obesity and life expectancy.
• The problem of discrimination of the obese people at the workplace.
• Could it be claimed that such movements as body-positive and feminism encourage obesity to a certain extent?

Best sample of obesity research paper outline

An outline is a table of contents which is made at the very beginning of your writing. It helps structurize your thoughts and create a plan for the whole piece in advance.

…Need a sample?

Here is one! It fits the paper on obesity in the U.S.

Introduction

• Hook sentence.
• Thesis statement.
• Transition to Main Body.
• America’s modern plague: obesity.
• Statistics and obesity rates in America.
• Main reasons of obesity in America.
• Social, cultural and other aspects involved in the problem of obesity.
• Methods of preventing and treating obesity in America.
• Transition to Conclusion.
• Unexpected twist or a final argument.
• Food for thought.

Specifics of childhood obesity research paper

A separate question in the problem of obesity is overweight children.

It is singled out since there are quite a lot of differences in clinical pictures, reasons and ways of treatment of an obese adult and an obese child.

Writing a child obesity research paper requires a more attentive approach to the analysis of its causes and examination of family issues. There’s a need to consider issues like eating habits, daily routine, predispositions and other.

Top 20 childhood obesity research paper topics

We’ve gathered the best ideas for your paper on childhood obesity. Take one of those to complete your best research!

• What are the main causes of childhood obesity in your country?
• Does obesity in childhood increase the chance of obesity in adulthood?
• Examine whether a child’s obesity affects academic performance.
• Are parents always guilty if their child is obese?
• What methods of preventing childhood obesity are used in your school?
• What measures the government can take to prevent children’s obesity?
• Examine how childhood obesity can result in premature development of chronic diseases.
• Are obese or overweight parents more prone to have an obese child?
• Why childhood obesity rates are constantly growing around the whole world?
• How to encourage children to lead a healthy style of life?
• Are there more junk and fast food options for children nowadays? How is that related to childhood obesity rates?
• What is medical treatment for obese children?
• Should fast food chains have age limits for their visitors?
• How should parents bring up their child in order to prevent obesity?
• The problem of socializing in obese children.
• Examine the importance of a proper healthy menu in schools’ cafeterias.
• Should the compulsory treatment of obese children be started up?
• Excess of care as the reason for childhood obesity.
• How can parents understand that their child is obese?
• How can the level of wealth impact the chance of a child’s obesity?

Childhood obesity outline example

As the question of childhood obesity is a specific one, it would differ from the outline on obesity we presented previously.

Here is a sample you might need. The topic covers general research on child obesity.

• The problem of childhood obesity.
• World’s childhood obesity rates.
• How to diagnose the disease.
• Predisposition and other causes of child obesity.
• Methods of treatment for obese children.
• Preventive measures to avoid a child’s obesity.

On balance…

The topic of obesity is a long-standing one. It has numerous aspects to discuss, sides to examine, and data to analyze.

Any topic you choose might result in brilliant work.

How can you achieve that?

Follow the basic requirements, plan the content beforehand, and be genuinely interested in the topic.

Option 2. Choose free time over struggle on the paper. We’ve got dozens of professional writers ready to help you out. Order your best paper within several seconds and enjoy your free time. We’ll cover you up!

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Free school meals for all may reduce childhood obesity, while easing financial and logistical burdens for families and schools

Ph.D. Candidate in Health Services, University of Washington

Associate Professor of Health Systems and Population Health, Epidemiology, University of Washington

Disclosure statement

Jessica Jones-Smith receives funding from the National Institutes of Health.

Anna Localio does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

University of Washington provides funding as a member of The Conversation US.

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School meals are critical to child health. Research has shown that school meals can be more nutritious than meals from other sources, such as meals brought from home.

A recent study that one of us conducted found the quality of school meals has steadily improved, especially since the 2010 Healthy, Hunger-Free Kids Act strengthened nutrition standards for school meals. In fact, by 2017, another study found that school meals provided the best diet quality of any major U.S. food source.

Many American families became familiar with universal free school meals during the COVID-19 pandemic. To ease the financial and logistical burdens of the pandemic on families and schools, the U.S. Department of Agriculture issued waivers that allowed schools nationwide to provide free breakfast and lunch to all students. However, these waivers expired by the 2022-23 school year.

Since that time, there has been a substantial increase in schools participating in the Community Eligibility Provision , a federal policy that allows schools in high poverty areas to provide free breakfast and lunch to all attending students. The policy became available as an option for low-income schools nationwide in 2014 and was part of the Healthy, Hunger-Free Kids Act . By the 2022-23 school year, over 40,000 schools had adopted the Community Eligibility Provision, an increase of more than 20% over the prior year.

We are public health researchers who study the health effects of nutrition-related policies, particularly those that alleviate poverty. Our newly published research found that the Community Eligibility Provision was associated with a net reduction in the prevalence of childhood obesity .

Improving the health of American children

President Harry Truman established the National School Lunch Program in 1946, with the stated goal of protecting the health and well-being of American children. The program established permanent federal funding for school lunches, and participating schools were required to provide free or reduced-price lunches to children from qualifying households. Eligibility is determined by income based on federal poverty levels, both of which are revised annually .

In 1966, the Child Nutrition Act piloted the School Breakfast Program , which provides free, reduced-price and full-price breakfasts to students. This program was later made permanent through an amendment in 1975.

The Community Eligibility Provision was piloted in several states beginning in 2011 and became an option for eligible schools nationwide beginning in 2014. It operates through the national school lunch and school breakfast programs and expands on these programs.

The policy allows all students in a school to receive free breakfast and lunch, rather than determine eligibility by individual households. Entire schools or school districts are eligible for free lunches if at least 40% of their students are directly certified to receive free meals, meaning their household participated in a means-based safety net program, such as the Supplemental Nutrition Assistance Program , or the child is identified as runaway, homeless, in foster care or enrolled in Head Start. Some states also use Medicaid for direct certification .

The Community Eligibility Provision increases school meal participation by reducing the stigma associated with receiving free meals, eliminating the need to complete and process applications and extending access to students in households with incomes above the eligibility threshold for free meals. As of 2023, the eligibility threshold for free meals is 130% of the federal poverty level, which amounts to US$39,000 for a family of four.

Universal free meals and obesity

We analyzed whether providing universal free meals at school through the Community Eligibility Provision was associated with lower childhood obesity before the COVID-19 pandemic.

To do this, we measured changes in obesity prevalence from 2013 to 2019 among 3,531 low-income California schools. We used over 3.5 million body mass index measurements of students in fifth, seventh and ninth grade that were taken annually and aggregated at the school level. To ensure rigorous results, we accounted for differences between schools that adopted the policy and eligible schools that did not. We also followed the same schools over time, comparing obesity prevalence before and after the policy.

We found that schools participating in the Community Eligibility Provision had a 2.4% relative reduction in obesity prevalence compared with eligible schools that did not participate in the provision. Although our findings are modest, even small improvements in obesity levels are notable because effective strategies to reduce obesity at a population level remain elusive . Additionally, because obesity disproportionately affects racially and ethnically marginalized and low-income children, this policy could contribute to reducing health disparities.

The Community Eligibility Provision likely reduces obesity prevalence by substituting up to half of a child’s weekly diet with healthier options and simultaneously freeing up more disposable income for low-to-middle-income families. Families receiving free breakfast and lunch save approximately $4.70 per day per child, or $850 per year. For low-income families, particularly those with multiple school-age children, this could result in meaningful savings that families can use for other health-promoting goods or services.

Expanding access to school meals

Childhood obesity has been increasing over the past several decades. Obesity often continues into adulthood and is linked to a range of chronic health conditions and premature death .

Growing research is showing the benefits of universal free school meals for the health and well-being of children. Along with our study of California schools, other researchers have found an association between universal free school meals and reduced obesity in Chile , South Korea and England , as well as among New York City schools and school districts in New York state .

Studies have also linked the Community Eligibility Provision to improvements in academic performance and reductions in suspensions .

While our research observed a reduction in the prevalence of obesity among schools participating in the Community Eligibility Provision relative to schools that did not, obesity increased over time in both groups, with a greater increase among nonparticipating schools.

Universal free meals policies may slow the rise in childhood obesity rates, but they alone will not be sufficient to reverse these trends. Alongside universal free meals, identifying other population-level strategies to reduce obesity among children is necessary to address this public health issue.

As of 2023, several states have implemented their own universal free school meals policies. States such as California, Maine, Colorado, Minnesota and New Mexico have pledged to cover the difference between school meal expenditures and federal reimbursements. As more states adopt their own universal free meals policies, understanding their effects on child health and well-being, as well as barriers and supports to successfully implementing these programs, will be critical.

• Childhood obesity
• Child health
• School meals
• National School Lunch Program
• K-12 education
• Health disparities
• School lunches
• Federal role in K-12 education

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Early Nutritional Education in the Prevention of Childhood Obesity

Mario gato-moreno.

1 Department of Pediatric Endocrinology, Regional University Hospital of Málaga, 29011 Málaga, Spain; moc.liamg@oneromotagoiram (M.G.-M.); moc.liamtoh@amleuh_lmairam (M.F.M.-L.); moc.liamg@rotevef (F.V.-T.); moc.liamtoh@atycnem (M.C.F.-T.); [email protected] (J.P.L.-S.)

María F. Martos-Lirio

Isabel leiva-gea.

2 Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; se.oohay@ujijapolebor

3 Department of Pharmacology and Pediatrics, Faculty of Medicine, University of Málaga, 29016 Málaga, Spain

M. Rosa Bernal-López

4 Department of Internal Medicine, Regional University Hospital of Málaga, 29009 Málaga, Spain

5 CIBER Fisiopatologia de la Obesidad y la Nutricion (Ciber Obn), Carlos III Health Institute, 28029 Madrid, Spain

Fernando Vegas-Toro

6 Ministry of Education and Sports, 29002 Málaga, Spain

María C. Fernández-Tenreiro

Juan p. lópez-siguero, associated data.

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical restrictions.

Early childhood is a critical period for obesity prevention. This randomized controlled study evaluated the effectiveness of an educational intervention preventing obesity in preschool-age children. A nutritional education intervention, with a follow-up session one year later, was conducted with parents of children aged 3 to 4 years of public schools in the province of Málaga. The main outcome variable was the body mass index z-score (zBMI). The prevalence of overweight or obesity was the secondary outcome variable. The sample comprised 261 students (control group = 139). Initial BMI, weight, height-for-age and prevalence of overweight and obesity were similar for both groups. After the first year of the intervention, the zBMI of the intervention group decreased significantly from 0.23 to 0.10 ( p = 0.002), and the subgroup of patients with baseline zBMI above the median decreased from 1 to 0.72 ( p = 0.001), and in the second year from 1.01 to 0.73 ( p = 0.002). The joint prevalence of overweight and obesity increased in the control group (12.2% to 20.1%; p = 0.027), while in the intervention group, there were no significant changes. This preschool educational intervention with parents improved their children’s BMI, especially those with a higher BMI for their age, and favored the prevention of overweight or obesity.

1. Introduction

In recent decades, the increase in the prevalence of childhood obesity has become a worldwide public health problem [ 1 , 2 ]. Recent studies in the United States analyzed the prevalence of obesity in children and found that it increases with age such that at 14 years of age, 20.8% of children are obese and 17% are overweight [ 3 ]. In Spain, the Aladino study (2019), which analyzed the national prevalence of obesity and overweight in schoolchildren aged 6 to 9 years, showed worrying figures: 40.6% of the schoolchildren analyzed were overweight. Of this percentage, 23.3% were overweight and 17.3% obese [ 4 ]. Similarly, an Andalusian study that assessed growth and prevalence of overweight and obesity in children [ 5 ] found the highest prevalence of overweight at 12 years old (26.8%) and of obesity at 8 years old (14%).

Different risk factors for obesity have been described, including male sex [ 6 ], obese parents [ 7 ], low socioeconomic status, high birth weight for gestational age [ 8 ], artificial formula feeding [ 9 ], rapid weight gain in the first months of life, excessive protein intake [ 10 ], early adiposity rebound [ 11 ], unhealthy dietary behaviors and sedentary lifestyle [ 12 , 13 ]. Childhood obesity is associated with multiple complications such as lipid metabolism disorders, hypertension, hyperinsulinism [ 14 ], hepatic steatosis, obstructive sleep apnea syndrome [ 15 ], chronic inflammation [ 2 ] and psychological problems [ 16 ].

Certain periods of childhood are crucial for obesity prevention, as they are associated with notable changes in adiposity. These periods include the first 2 years of life, the period of adiposity rebound (between 5 and 7 years of age) and puberty [ 17 ]. Early childhood is a critical period for the development of obesity [ 18 ]. Indeed, the increase in body mass index (BMI) begins at around 4 or 5 years of age, and it has been shown that children who are overweight at 5 years of age are 4 times more likely to become obese later in life [ 3 ]. Once excess weight is established, it is difficult to reverse and the probability of becoming obese in adulthood increases, which makes early intervention necessary [ 19 ]. The prevention of childhood obesity is an international health priority and should be initiated in the prenatal period, maintaining appropriate weight gain during pregnancy. It is also advisable to introduce proper breastfeeding and complementary feeding, promote active play, avoid a sedentary lifestyle, ensure sufficient sleep [ 20 ] and adhere to the Mediterranean diet, which has been shown to reduce the risk of overweight and obesity [ 21 ].

The main objective of intervention programs to prevent childhood obesity is to improve nutrition and physical activity in the youngest children, since the rate of failure and relapse in established obesity is high [ 22 ]. These programs should have the following characteristics: broad scope, cost-effective policy, social perspective, and a multi-sectoral and multi-level approach [ 20 , 23 ].

The school is an ideal place to carry out lifestyle interventions, since schoolchildren spend a large number of hours in this setting [ 24 ]. Additionally, it allows access and a close contact with a population that is already gathered and will likely be available over time. The most effective interventions are those that combine diet with physical exercise in children aged 0 to 5 years [ 25 ]. School-based interventions have been found to be effective in reducing the BMI [ 26 ] of children, and this intervention, when implemented in the home, can even improve the BMI of their parents [ 27 ]. The aim of this study was to determine the impact of a school-based educational intervention on eating behavior and physical activity aimed at the parents of children aged 3 to 4 years and on the evolution of BMI and the prevalence of overweight or obesity in their children in the 2 years following the intervention. Our hypothesis is that the preschool-aged children whose parents receive an educational intervention can improve their BMI.

2. Materials and Methods

This was a school-based parent-only intervention study involving an education program for parents of children at the beginning of their schooling and was designed as a randomized clinical trial with a control group. We included parents of students aged 3 to 4 years in public schools in the province of Málaga, Spain, who agreed to participate in the study (n = 261). None of the students had a serious chronic disease with a high risk of malnutrition that was a reason for exclusion. A single-stage cluster sampling (centers) stratified by counties was undertaken so that all areas of the province of Málaga were represented. Then, a stratified randomization of these centers considering rural and urban areas of Málaga was performed to establish the intervention group (IG, n = 122) and the control group (CG, n = 139). The schools formed units assigned to the same group, that is, each complete center was either intervention or control. Baseline homogeneity between groups was confirmed. The duration of the study was 2 years.

The intervention was carried out by a dietetic technician in collaboration with school physicians (Educational Guidance Teams). In the IG, the first intervention was delivered at the beginning of the first year through a set of six 2 h group training sessions, given every two weeks; and a follow-up intervention at the beginning of the second year through a 3 h session. In these six sessions, group and interactive activities were used to address the following topics: introduction to nutrition, healthy eating habits, keys to improving nutrition and eating habits, designing healthy and attractive menus, physical activity and food labeling. In the annual follow-up session, the topics of nutrients and their importance, healthy menus and physical activity were revisited. Sessions were aimed to parents, thus children were not present. These interventions are described in Appendix A .

2.1. Variables

Auxological assessment was performed at the beginning of the first year of schooling (time 0) and at the end of the first and second years (times 1 and 2). Weight was determined using a Taurus Oslo model scale with a maximum weight capacity of 150 kg and accurate to 0.1 kg, recording the mean of two consecutive measurements. For weight measurement, the subjects were barefoot and wearing light clothing. Standing height was measured with a Seca 213 portable stadiometer, accurate to 0.1 cm. The mean of two consecutive measurements was recorded. The measurements were in kg and cm, respectively, to one decimal place. Quantitative variables were expressed as means ± standard deviation (SD) and dichotomous variables as percentages.

The response variable was the variation in BMI z-score (zBMI) using the reference values for sex and age from Spanish Growth Studies 2010 [ 28 ]. The zBMI was used to measure changes in the children since, unlike the absolute value of other variables such as weight or BMI, this variable reflects more accurately changes in a child’s body composition over time and is adjusted according to sex, independently of the increase in weight due to growth. The secondary variable was the prevalence of overweight or obesity. Overweight was considered to be a BMI between the 85th and 95th percentiles and obesity equal to or above the 95th percentile [ 29 ].

2.2. Statistical Analysis

The data were analyzed with R 4.0.2 software (R Core Team 2020). The fit of the variables to the normal distribution was tested with the Shapiro–Wilk test. The only variable that followed a normal distribution and used the student’s t-test was zHeight. The Mann–Whitney U test was used in the rest of the quantitative variables of Table 1 . The Wilcoxon signed-rank test was used for quantitative variables of Table 2 and Table 3 in related samples that did not follow a normal distribution. To compare variables expressed as percentages, the χ² test was used in independent samples ( Table 1 ) and McNemar’s test in related samples ( Table 4 ). A p value of less than 0.05 was considered statistically significant. Discrete variables were expressed as percentages and continuous variables as mean ± standard deviation or median (interquartile range), depending on whether or not they conformed to the normal distribution. An “intention to treat” analysis strategy was utilized. The statistical analysis and results were validated by an independent professional statistical team (Biostatech).

Characteristics of the participants at the beginning of the study.

Data are expressed as mean ± standard deviation or as percentage. zBMI: body mass index standard deviation score, zWeight: weight standard deviation score, zHeight: height index standard deviation score, zBMI > 0 (median) individuals with a zBMI value greater than 0, which is the median value of the total sample. * Significant difference between groups.

Evolution of the body mass index z-score (zBMI) in the participants of the control and intervention groups during the study.

Data are expressed as mean ± standard deviation. The baseline value at the beginning of the study is compared with the final value at the end of the first year in the first row and the final value at the end of the second year in the second row. * Significant change compared to baseline (before the intervention).

Evolution of body mass index z-score (zBMI) in the participants of the control and intervention groups stratified according to the baseline zBMI of the students.

Data are expressed as mean ± standard deviation. The baseline value at the beginning of the study is compared with the final value at the end of the first year in the first row and the final value at the end of the second year in the second row. * Significant change compared to baseline (before intervention).

Evolution of the prevalence of overweight and obesity in the participants of the control and intervention groups during the study.

Data are expressed as percentage. The baseline value at the beginning of the study is compared with the final value at the end of the first year in the first row and the final value at the end of the second year in the second row. * Significant change compared to baseline (before intervention).

A total of 261 students were included with a mean age of 44.9 ± 4.63 months and 46.4% were female. The CG comprised 139 students and the IG 122. The flow diagram of the participants is shown in Figure 1 . The losses were associated with a change of school or failure to attend class on the day of the auxological assessment.

Study flow diagram.

CG individuals were significantly younger (1.93 ± 0.56 months). No significant differences were found at baseline between the groups for the rest of the variables studied. Both groups had similar BMI, weight and height-for-age, with no differences by sex. Both groups also had a similar proportion of students with zBMI over the median (value = 0), and of overweight and/or obese individuals (see Table 1 ).

The changes observed in the zBMI in the CG and IG during the two years of this study are provided in Table 2 . In the CG, the evolution of zBMI showed no significant changes in either year of the study. However, in the IG, a significant decrease in zBMI was observed both after the first year of the intervention (baseline 0.23 ± 1.18, final 0.10 ± 0.99; p = 0.002), and after comparing the baseline zBMI with that of the second year (baseline 0.24 ± 1.21; final 0.14 ± 1.05; p = 0.021). The variation observed in the number of baseline data from the first and second year is due to the loss of following-up some patients in the second year.

When analyzing the evolution of the zBMI stratified into subgroups according to whether the initial zBMI was lower or higher than the median of the total sample (with a value of 0), it was observed that in the subgroup of patients with zBMI lower than or equal to the median, the zBMI showed a similar evolution in both the CG and the IG, with no significant changes in any of them during the 2 years of the study. However, in the subgroup of patients with zBMI above the median, a different evolution was observed between the zBMI of the CG and the IG (see Table 3 ). While in the CG there were no significant differences in the evolution of the zBMI, in the IG there was a significant decrease of 0.28 points in the zBMI, both in the first year (baseline 1.00 ± 1.30, final 0.72 ± 1.05; p = 0.001) and in the second year (baseline 1.01 ± 1.32, final 0.73 ± 1.15; p = 0.002).

Regarding the evolution of the combined prevalence of overweight or obesity, no significant differences were found during the first year, in either the CG or the IG (see Table 4 ). However, when comparing the baseline prevalence with the prevalence after 2 years, a statistically significant increase of 7.6% in the prevalence of overweight and obesity was found in the CG (initial 12.2%, final 20.1%; p = 0.027), while in the IG, there were no significant changes.

4. Discussion

The main objective of this research was to evaluate the effectiveness of a training program given to parents of children 3 to 4 years of age on the evolution of BMI. In this study, the main effect observed was a decrease in zBMI in the IG, which did not occur in the CG. This effect occurred mainly in the first year after the intervention, and in children with a baseline zBMI above the median of the total sample.

This decrease in the zBMI in the IG one year after the intervention showed a clear benefit of the intervention with respect to the CG. One of the main advantages of this school-based intervention was the availability of a localized sample in schools, which facilitated the achievement of a cost-effective prevention intervention with a broad scope [ 24 ], including 70% of the children in the province aged 3 years. Other interventions carried out in Spanish schools, such as that performed by Pérez-Solís et al. [ 30 ] have also shown positive effects in reducing the zBMI (reduction between 1.14 and 1.02 in the IG) in children aged 6 years and older. However, the older age of the intervention subjects in the study by Pérez-Solís et al. allowed their intervention to be carried out directly with the children through workshops, talks and written material in the school, instead of only with the parents, as in our study.

Other interventions performed with parents of children of similar ages to those in our study have also found positive results, with a decrease in zBMI one year after receiving nutritional education [ 31 ]. The intervention by Slusser et al. showed greater effectiveness than ours (IG −0.20 versus CG +0.04), which could be associated with the longer duration of the intervention. The magnitude of the benefit is directly proportional to the time dedicated to parent education. Concerning this approach, a recent systematic review indicates that the most effective interventions are those that last more than 6 months with sessions at least every 2 weeks [ 32 ].

Despite the marked benefit of the intervention shown after the first year, the protective effect was diminished at 2 years. This suggests that the follow-up session at 1 year (3 h) may be insufficient to maintain adherence and may not have the same effect as the initial intervention. However, it is important to consider that this follow-up session was attended by only 22% of the IG parents compared to 100% who attended the initial intervention.

The subgroup analysis nonetheless showed that the intervention particularly benefited children with a zBMI higher than the median of the total sample, demonstrating a scope that not only prevented an increase in zBMI, but also helped to reduce these values. In addition, it was shown to significantly prevent an increase in the prevalence of overweight or obesity in the IG compared to the CG 2 years after the initial intervention. This protective effect for the increase in prevalence was particularly evident in the first year. From the first to the second year, a similar but not statistically significant increase in prevalence was observed in both study groups, most likely due to the loss of effect of the initial intervention and the poor adherence to the follow-up intervention in the IG. In this aspect, our study obtained better results than Pérez-Solís, who, after 2 years of intervention found no change in the prevalence of overweight or obesity between the CG and the IG.

The magnitude of the decrease in zBMI achieved with our intervention in children with higher zBMI was particularly significant when we consider that early childhood (3–6 years) is a key period for establishing habits and where overweight and obesity begin to appear. Multiple studies show that weight at 5 years of age is a good predictor of weight at 9 years of age [ 33 , 34 ], and could be associated with the development of future metabolic complications such as diabetes [ 35 ]. For this reason, the preschool stage may be the best time to implement strategies for the prevention of all conditions associated with overweight and obesity. It is also important to raise awareness among parents that overweight and obesity are increasing trends that generally do not disappear as children grow older, and therefore should be addressed as soon as possible [ 13 , 36 ].

In addition to the clear benefit demonstrated for the children, the nutritional education received by the parents may also result in an improvement in the eating habits of the other members of the family [ 37 ]. Although our study did not assess the effect that may have occurred in families, international studies of interventions at the family level to prevent childhood obesity have found that parents experience an improvement in their body composition as a secondary effect of the intervention [ 27 ].

The novel aspect of this study is that it is one of the first to evaluate the effectiveness of a nutritional education intervention in the population of preschool-aged children in southern Europe.

The main limitations of this study were the loss to follow-up of the participants, and the decreased adherence to the intervention in the annual follow-up phase. Ideally, the duration and frequency of the intervention sessions should be increased to improve their effectiveness. However, lack of parental adherence to the intervention could detract from the effectiveness of the intervention. Furthermore, no method was established to verify that the intervention covered all the planned aspects, such as the recording of the sessions carried out. Moreover, the baseline homogeneity of physical activity and eating habits between groups was not analyzed directly. Although the differences in physical activity levels generally are not very important at this age, we did analyze other baseline outcome variables that could be indirectly related to these behavioral parameters (zBMI, percentage zBMI > 0, percentage of overweight and/or obese students).

For future interventions, we recommend emphasizing the use of content adapted to foods available by season, area, customs and family economy, in order to promote better adherence and avoid the stigma that healthy eating is perceived as more expensive [ 30 ]. The emotional aspect derived from the relationship that individuals have with food should also be taken into account and addressed in the context of an efficient program focused on preserving health, not on weight loss as the ultimate goal. We also found that it would have been interesting to analyze the demographic characteristics of the parents to identify possible barriers that could hinder the intervention, in this way, strategies to overcome these barriers could be implemented.

5. Conclusions

This parent-only intervention program administered in the school setting at the initiation of early childhood education achieved a significant improvement in the BMI of the children whose parents received the educational intervention, especially in the children who started with a high BMI for their age. This type of educational intervention with such a young target population appears to be an effective and promising strategy to prevent excess weight and its long-term health consequences. Education on nutrition and physical activity should therefore be recommended as part of school activities from the age of 3 years with the participation of parents. Nevertheless, further studies in this field with larger sample sizes and longer follow-up times are needed to confirm and better delimit the beneficial effects demonstrated in our study, both in the short and long term in the life of the child.

Acknowledgments

The authors thank Biostatech Advice Training & Innovation in Biostatistics, S.L., for statistical review.

Appendix A. Nutrition and Physical Activity Education Program

The objectives and topics covered in the supervised activities included in the sessions of this educational program are detailed below:

• ○ Knowledge of basic concepts: Nourishment and eating habits, Nutrition, Foods, Diet, Diet therapy.
• ○ Understanding the concept of obesity and overweight, its various causes and possible consequences.
• ○ Learn the different nutrients and their function in the human body: macronutrients, carbohydrates and sugars (starches), proteins, lipids, fats, micronutrients, vitamins and minerals.
• ○ Recognizing one’s own eating habits and which factors could be modified.
• ○ Assessing the importance of good eating habits for health.
• ○ Recognizing the social importance of food and nutrition in all its dimensions, which influence and establish the eating patterns of populations.
• ○ Learn the 7 food groups and become familiar with the main nutrients provided by each of them.
• Analyze, understand and develop skills associated with behavior at the table at mealtime.
• ○ Become aware of the uses of eating in different situations: calming anxiety, compensating frustration, comfort.
• ○ Ten principles of a diet.
• ○ Understand the concept of food servings and how to adapt the criteria for a balanced diet such as servings of the different food groups.
• ○ Recognize the importance of food choice, frequency, serving size and volume over a period of time to maintain good health.
• ○ Describe your own diet, assessing the possibilities of defining it as healthy based on your own knowledge about Nutrition—Health.
• ○ Understand the most important aspects to be considered when designing a meal plan.
• ○ Learn to use food servings with new recipes.
• ○ Understand the meanings of terms used on food labels.
• ○ Learn to recognize the healthiest foods by reading the ingredients and the nutritional information of the label.
• ○ Learn how sports can be beneficial on a physical, psychological and emotional level.
• ○ Simple ways to encourage physical activity.
• ○ Review the different nutrients and their importance in the diet.
• ○ Review the preparation of a healthy menu.
• Review the benefits of physical activity and how to stimulate it.

Author Contributions

Conceptualization, J.P.L.-S. and I.L.-G.; methodology, J.P.L.-S., F.V.-T. and M.C.F.-T.; resources F.V.-T. and M.C.F.-T.; data curation, M.G.-M. and M.F.M.-L.; formal analysis, M.G.-M.; investigation, M.G.-M. and M.F.M.-L.; writing—original draft preparation, M.G.-M. and M.F.M.-L.; writing—review and editing, M.G.-M., M.F.M.-L., J.P.L.-S. and I.L.-G.; supervision J.P.L.-S., M.R.B.-L. and I.L.-G. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to Good Clinical Practice (document 11/3976/88; July, 1990) and the 1965 Helsinki declaration and its later amendments. Ethical approval for this study was obtained from the Ethics Committee of Málaga (2542-N-20).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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