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A review of the evidence:
School-based
interventions to address
obesity in children 6-12
years of age
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The Health Evidence Team
Kara DeCorby Heather Husson Jennifer Yost
Managing Director Project Manager Guest Presenter
Maureen Dobbins
Scientific Director
Tel: 905 525-9140 ext 22481
E-mail: dobbinsm@mcmaster.ca
Lori Greco Robyn Traynor Lyndsey McRae
Knowledge Broker Research Coordinator Research Assistant

What is www.health-evidence.ca?
Evidence
inform
Decision Making

Why use www.health-evidence.ca?
1. Saves you time
2. Relevant & current evidence
3. Transparent process
4. Supports for EIDM available
5. Easy to use

Knowledge Translation
Supplement Project
CIHR-funded KTB-112487

A Review of the Evidence:
School-based Interventions to Address
Obesity in Children 6-12 Years of Age

• Julie Charlebois
Health Promotion Consultant
• Paula Waddell
Health Promotion Consultant

Overview
• Partnerships for Health System
Improvement Project Goal
• Introduction to Evidence-Informed
Decision Making
• A Review of the Evidence
• Recommendations
• Next Steps

Partnerships for Health System Improvement
• Health Evidence was awarded a CIHR grant
• Health Evidence is partnering with three
Ontario public health units
• Exploring how to best enhance capacity for
and facilitate contexts conducive to EIDM in
public health

What is Evidence-Informed Decision Making?
The process of distilling and disseminating the
best available evidence from research,
practice and experience and using that
evidence to inform and improve public health
policy and practice
National Collaborating Centre for Methods and Tools (NCCMT)

Stages of Evidence-Informed
Decision Making
Step 1: Define
Step 2: Search
Step 3: Appraise
Step 4: Synthesize
Step 5: Adapt
Step 6: Implement
Source: National Collaborating Centre for Methods
and Tools (NCCMT) Step 7: Evaluate

Model of EIDM in Public Health
Community Community and
Health Issues, Political
Local Context Preferences
and Actions
Public
Health
Expertise
Research Public Health
Evidence Resources
National Collaborating Centre for Methods and Tools
DiCenso, A., Ciliska D., Haynes B., & Guyatt, G. 2005

Step 1: Define
Research Question 1:
What interventions or strategies are most effective in
low-income communities/neighbourhoods to address
risk factors related to obesity?
P (Population): Low-income Communities
I (Intervention): Best Intervention
C (Comparison): N/A
O (Outcome): Factors influencing healthy weights and obesity
prevention

Step 1: Define
Research Question 2:
What school-based programs are effective in
increasing physical activity participation in higher
needs elementary schools?
P (Population): Children in higher needs elementary
schools
I (Intervention): School-based physical activity programs
C (Comparison): N/A
O (Outcome): Increasing participation in physical activity

Step 2: Search
START HERE

Step 2: Search (Search Terms)
Research Question #1:
“obesity; obesity and low income; obesity and
low income and program; obesity and low
income and physical activity and nutrition"
Research Question #2:
"school and physical activity programs; school
and physical activity and programs and high
risk"

Step 2: Search (Tracking Tool)

Step 2: Search (Databases and Timeframe)
Guidelines and Systematic Reviews
Electronic Databases:
• Guideline Advisory Committee (GAC)
• National Guidelines Clearinghouse (NGC)
• Turning Research into Practice (TRIP) Database
(Guidelines and Systematic Reviews)
• Health Evidence
• Centre for Reviews and Dissemination (CRD)
• Eppi-Centre
• Cochrane Collaboration
• PubMed Clinical Queries
Time Frame:
• Searched from 2007 to May 2012

Step 3:
Appraise
Quality
Assessment Tool
for Systematic
Reviews:

Appraise
Quality Assessment
Tool for Guidelines:

Quality Assessment Summary (Appendix B)
Total: 9 Systematic Reviews & 2 Guidelines

New PICO Question
What school-based programs are effective in
low-income communities/neighbourhoods to
address risk factors related to obesity in
children ages 6-12?

Step 4: Synthesize
Characteristics:
(Appendix C)
- Author, Date, Place of
Publication Outcomes:
- # of Primary Studies, Type of (Appendix D)
Studies
- Theoretical Basis - Author, Year, Place of Publication
- Settings
- Outcome Measures
- Target Audience
- Results
- Intervention Length
- General Implications
- Mode of Delivery
- Comments/Limitations
- Provider
- Parent/Guardian Involvement

Step 4: Synthesize (Results)
Results were synthesized from 410 articles
describing 364 separate interventions
Results analyzed according to categories:
√ Physical Health Status Measures (5 Reviews)
√ Physical Activity Measures (4 Reviews)
√ Dietary Measures (3 Reviews)
√ Psychosocial Measures (2 Reviews)

Step 4: Synthesize (Results)
The categories were further sub-divided into one or more of
the following topics:
√ Dietary-based Interventions
√ Physical Activity-based Interventions
√ Psychosocial/psychoeducational Variables
√ Duration
√ Family and Community Involvement
√ Intervention Delivery Based on Setting and Provider
√ Tailored Programs
√ Education Only Interventions
√ Multi-component Interventions
√ Environmental or Policy-based Interventions
√ Peer Leaders and Incentives

Step 4: Synthesize (Recommendations)
Setting and Audience:
TPH should implement obesity prevention interventions in the school
setting.
TPH should implement obesity prevention interventions targeting children
ages 6–12 (elementary school aged).
TPH should deliver obesity prevention interventions to mixed gender
groups.
TPH should implement obesity prevention interventions in schools in lower
socio-economic neighbourhoods to increase physical activity levels and
improve dietary intake.
TPH should implement obesity prevention interventions that target all
children versus interventions that target high risk populations who are
already overweight or have risk factors of becoming overweight.

Step 4: Synthesize (Recommendations)
Dietary-based Interventions:
TPH should not implement dietary-based interventions alone to improve
anthropometric measures.
TPH should implement dietary-based interventions to improve dietary
intake and/or behaviour (vs. anthropometric measures alone).
TPH should implement environmental or policy-based interventions such
as breakfast and/or fruit and vegetable distribution programs to improve
dietary intake.
TPH should not implement environmental or policy-based interventions
focussing on system-wide nutritional change to improve anthropometric
measures.

Step 4: Synthesize (Recommendations)
Physical Activity-based Interventions:
TPH should implement physical activity-based interventions that decrease
sedentary behaviours to improve anthropometric measures.
TPH should implement physical activity-based interventions that focus on
extended physical education classes and activity breaks to improve
anthropometric measures.
TPH should not implement physical activity-based interventions involving
fitness enhancement to improve anthropometric measures.
TPH should implement physical activity-based interventions to increase
physical activity measures including physical activity and /or sedentary
levels. The use of activity breaks is one intervention that has been shown
to be successful.

Step 4: Synthesize (Recommendations)
Physical Activity-based Interventions: (continued)
TPH should not implement physical activity curriculum alone to increase
physical activity levels.
TPH should implement environmental or policy-based interventions to
increase physical activity levels (e.g., playground game equipment and
activity cards provided, playground painted with florescent marking
designs and games by students).

Step 4: Synthesize (Recommendations)
Multi-risk Approach:
TPH should implement a combination of physical activity and
dietary-based interventions to improve anthropometric
measures as well as physical and dietary behaviours.

Step 4: Synthesize (Recommendations)
Multi-component Approach:
TPH should incorporate a multi-component approach to obesity
prevention including behavioral, environmental, and educational
components including health education, enhanced physical education,
and promotion of healthy food options. In particular, the education
component should be multi-risk.
TPH should not implement either physical activity or dietary-based
education in isolation due to its limited impact as an obesity prevention
intervention.

Step 4: Synthesize (Recommendations)
Other Intervention Components:
TPH should include psychosocial/psychoeducational components in
physical activity and dietary-based interventions (e.g. activities
increasing knowledge/attitudes/preferences, self-esteem, well-being
and/or quality of life).
TPH should implement physical activity and/ or dietary-based
interventions lasting at least 3 months.
TPH should incorporate a family component into all obesity prevention
interventions.
TPH should aim for a high level of parental involvement in obesity
prevention interventions (e.g. behaviour change goal for parents).

Step 4: Synthesize (Recommendations)
Other Intervention Components: (continued)
TPH should use peer leaders in interventions focussing on obesity
prevention.
TPH should use incentives in interventions focussing on increasing fruit
and vegetables consumption (e.g. rewards provided when fruit and
vegetable servings are eaten at school).
TPH should continue to partner with school staff and intervention
specialists in the school setting in order to maximize the impacts of
obesity prevention interventions.
Overall, TPH should address harm or unintended effects when
planning, implementing and evaluating obesity prevention interventions.

Step 5: Adapt
Assessment of Applicability
and Transferability

Next Steps
• Applicability and transferability tool
• Examine current TPH programs for gaps and
opportunities
• Develop pilot project
Ongoing:
Knowledge Brokering within Toronto Public Health
• CDIP Consultants, Healthy Communities Consultants
• CDIP child staff
• Healthy Communities school youth team staff
• Other TPH PHSI project staff

Thank you
Julie Charlebois
Health Promotion Consultant
Toronto Public Health
jcharle@toronto.ca
Paula Waddell
Health Promotion Consultant
Toronto Public Health
pwaddell@toronto.ca
Health Evidence
info@health-evidence.ca

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