Effectiveness of School-Based Interventions Versus Family-Based I

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Effectiveness of School-based Interventions versus

Family-based Interventions in the Prevention and
Treatment of Childhood Obesity
Ashley Capestrain
The University of Akron, anc69@zips.uakron.edu
Emily Montague
The University of Akron, enm19@zips.uakron.edu
Meghan Frantz
The University of Akron, mef45@zips.uakron.edu
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Recommended Citation
Capestrain, Ashley; Montague, Emily; and Frantz, Meghan, "Effectiveness of School-based Interventions versus
Family-based Interventions in the Prevention and Treatment of Childhood Obesity" (2017). Honors Research
Projects. 439.
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1
Running head: CHILDHOOD OBESITY
Effectiveness of School-based Interventions versus Family-based Interventions in the Prevention
and Treatment of Childhood Obesity
Ashley Capestrain, Meghan Frantz, Emily Montague
The University of Akron
Author Note
Ashley Capestrain, Meghan Frantz, & Emily Montague, College of Nursing, The University of
Akron, This paper is in fulfillment for the Honors College, Due May 2017, Professor Christine
Heifner Graor, PhD, MSN, APMHCNS-BC, RN

CHILDHOOD OBESITY 2
Abstract
Childhood obesity affects 155 million children worldwide. As prevalence increases, it is
important to identify effective interventions in the treatment and prevention of childhood obesity.
Obesity may result in short and long term effects linked to some of the leading causes of
morbidity and early mortality. The purpose of this systematic review is to identify, review, and
critically appraise evidence from studies examining the effect of family and school based
interventions. This review answers the following PICO question: In children, how do family
based interventions compare to school based interventions, in the prevention and treatment of
obesity? Methods included literature searches in university databases and Google Scholar for
relevant studies. Studies were critically appraised for their validity, reliability, and limitations. It
was found that both school and family interventions are beneficial in decreasing body mass index
(BMI), increasing physical activity, improving nutrition and dietary habits, decreasing blood
pressure and cholesterol, and improving attitudes and psychosocial outcomes. A definitive
conclusion cannot be drawn to determine if school or family based interventions result in a better
outcome. Thus, further research is needed that compares school and family based interventions
in the prevention and treatment of childhood obesity.

CHILDHOOD OBESITY 3
There is an increasing prevalence of childhood obesity throughout the world. It affects
155 million school-aged children and young people globally (Kothandan, 2014). Of the world’s
43 million overweight and obese preschoolers, 35 million live in developing countries. By 2020,
if this current epidemic continues 9 percent, or nearly 60 million, of all preschoolers will be
overweight or obese (“Obesity Trends,” 2017). Obesity is defined as a body mass index (BMI) at
or above the 95th percentile for children and teens of the same age and gender (“Defining
Childhood Obesity,” 2015). Obesity is considered to be a major public health issue and is linked
to some of the leading causes of morbidity and early mortality (Greening, Harrel, Low, &
Fielder, 2011). Some of the health complications resulting from childhood obesity include
diabetes, cardiovascular disease, obstructive sleep apnea, nonalcoholic fatty liver disease, and an
increased likelihood of ischemic heart disease and breast cancer in adulthood (Anderson, Newby,
Kehm, Barland, Hearst, 2015). Early childhood has been identified as a crucial time for obesity
prevention based on children’s developmental patterns, including stabilization of health
behaviors that can lead to obesity, and the large influence of environmental factors on children’s
regulation of eating (Brotman et al., 2012). Current studies have yet to identify the most effective
strategy for childhood obesity management (Elizondo-Montemayor et al., 2013). Since obesity
has shown to be a major health crisis globally, there is a need for effective interventions to
decrease the prevalence of obesity in children.
Many current research studies look at treating childhood obesity with school or family
based interventions. However, most research has yet to compare these two interventions in the
prevention and treatment of childhood obesity. School based interventions include actions taken
in schools to assist children in the prevention or treatment of obesity independent from family.
Family based interventions include actions taken with the child’s parents or caregiver in the
CHILDHOOD OBESITY 4
home to help prevent or treat obesity. The purpose of this review is to identify, review, and
critically appraise the evidence from studies examining the effect of family based intervention
and school-based interventions on childhood obesity. This review answers the following PICO
question: In children, how do family based interventions compare to school based interventions,
in the prevention and treatment of obesity? Based on the critical appraisal of evidence,
recommendations for practice and research are made.
Methods
The literature search was conducted within a university database system. Databases used
were CINAHL, Medline, Google Scholar, and Health Source: Nursing/Academic Edition.
Inclusion criteria were: family and/or school as an intervention for obesity, children, defined as
under eighteen years of age, and publications after December 2004. Study designs included are
randomized control trials, intervention studies, qualitative studies, quasi-experimental designs, a
longitudinal cohort study, pre-post designs, and an observational study. Exclusion criteria were:
publications prior to 2004 and systematic reviews. Keywords or phrases used include obesity,
pediatric, school based intervention, family based intervention, childhood obesity, school
intervention, family intervention, school, and family. Articles were retained as potential sources
based on the title of the articles as well as a brief scan of the abstract. Studies that seemed fitting
were read thoroughly before being selected as sources. They were assessed based on the criteria
set forth prior to being selected for review. Twenty studies were evaluated for quality based on
methods for choosing participants, use of family or school as the intervention, use of a control
group, and the use of reliable measures. Selection bias was avoided by including studies with
conflicting results. For this review, the rating system proposed by Burns, Rohrich, and Chung
(2011) was used.

CHILDHOOD OBESITY 5
Review of Literature
Childhood obesity has become a major global health problem (Anderson, Newby, Kehm,
Barland, & Hearst, 2015; Brotman et al., 2012; Cadzow, Chambers, & Sandell, 2015; Cao,
Wang, & Chen, 2015; Chen, Kao, Hsu, Wang, & Hsu, 2015; Davison, Jurkowski, Li, Kranz, &
Lawson, 2013; Elizondo-Montemayor, et al., 2013; Fagg, et al., 2014; Greaney, et al., 2014;
Greening, Harrell, Low, & Fielder, 2011; Greiner, Lian, & Rosenqvist, 2005; Jiang, Xia, Lee,
Ho, Keung, & Kwong, 2014; Leardo, Aneja, & Elbel, 2016; Lederer, King, Sovinski, Seo, &
Kim, 2015; Ling, King, Speck, Kim & Wu, 2014; Rodrigues, Alves, Barreto & Freitas, 2015;
Sacher et al., 2010; Schwartz, Watson et al., 2015; Steele, Steele, & Cushing, 2012; Teder, et al.,
2013). Many researchers have found that childhood obesity can cause numerous short and long
term effects associated with early morbidity and mortality (Adab et al., 2015; Anderson et al.,
2015; Cadzow et al., 2015; Cao et al., 2015; Elizondo-Montemayor, et al., 2013; Greening et al.,
2011; Rodrigues et al., 2015). Current research studies focus on using only school or family
based interventions in the treatment of childhood obesity; however, most research has yet to
compare these two interventions together in the prevention and treatment of childhood obesity.
Due to this gap in knowledge, the increasing prevalence of childhood obesity, and the increased
risk for early morbidity and mortality, it is imperative to determine the most effective
intervention for treating and preventing obesity in children and young people. Refer to Appendix
A for the breakdown of searched articles.
School Based Interventions
Researchers have studied the effect of school-based interventions on the treatment and
prevention of childhood obesity (Benjamins, & Whitman, 2010; Cadzow, et al., 2015; Elizondo-
Montemayor, et al., 2013; Greaney, et al., 2014; Greening et al., 2011; Lederer et at., 2015; Lee
CHILDHOOD OBESITY 6
et al., 2014; Ling et al., 2014; Rodrigues et al., 2015; Schwartz et al., 2016). It has been
identified that children spend most of their time in school, therefore school is considered an ideal
setting for a healthy lifestyle promotion program (Ling et al., 2014). Of the 10 articles reviewed,
numerous effects were found from using school based interventions including, BMI; physical
activity; nutrition and dietary habits; blood pressure and cholesterol; and attitude and
psychosocial outcomes. Each effect is discussed in depth below.
Body Mass Index. Several articles found positive effects from school based interventions
on children’s BMI and percentage of body fat. BMI is a measurement of body fat that is based on
height and weight (“Calculate your body mass index,” 2016). Students receiving school-based
intervention decreased their BMI z-score compared to those who did not receive the intervention
with statistical significance (Cadzow et al., 2015; Lee et al., 2014; Schwartz et al., 2016). It was
also found that children who received school based interventions had a statistically significant
decrease in their percentage of body fat (Elizondo-Montemayor, et al., 2013; Greening et al.,
2011; Lee et al., 2014; Schwartz et al., 2016). Lee et al. (2014) found that those receiving school
based interventions continued to have a significant reduction in BMI z-score and body fat after a
four-month maintenance period as well. Schwartz et al. (2016) found that an increase in water
consumption while participating in school based interventions showed a decrease in BMI. Some
of these studies lacked a control group, which may have biased the findings (Cadzow et al.,
2015; Elizondo-Montemayor, et al., 2013; Ling et al., 2014). For example, effects of the school
based intervention may be attributed to confounding factors such as the environment,
socioeconomic status, and ethnicity. Greening et al. (2011) took this bias into account and
provided a randomized controlled trial with intervention and control groups. This study was a
level of evidence of one and found no differences in outcomes based on gender, ethnicity, or
CHILDHOOD OBESITY 7
race. BMI has been found to be predictive of elevated fat mass and percentage body fat when
above the 85th percentile in children.
Physical Activity. Many studies looked at the effects of school based interventions on
children’s post-intervention physical activity levels. Five studies found that school based
interventions led to an overall increase in physical activity among children (Benjamins &
Whitman, 2010; Cadzow et al., 2015; Elizondo-Montemayor et al., 2013; Greening et al., 2011;
Ling et al., 2014). Ling et al. (2014) found that the effects of the school based intervention on
physical activity depended on school, grade, and age of the children. A randomized controlled
trial of 450 children, ages 6-10 years old, in Mississippi, found that students who received the
school based intervention of participating in monthly physical activity and nutritional events
during the nine-month academic year showed statistically significant improvement in physical
activity (Greening et al., 2011). Greening et al. (2011) also found that a school based
intervention led to a statistically significant increase in performance on physical activity tests
including, such as, jump rope, hula hoop, baseball throws, and foot races, compared to those who
did not receive the school based intervention.
Nutrition and Dietary Habits. Many researchers examined the effects of school-based
interventions on children’s nutrition and dietary habits. After receiving school based
interventions, many children showed an improvement in dietary habits (Greening et al., 2011;
Lee et al., 2014; Ling et al., 2014). Ling et al., (2014) conducted a quasi-experimental study with
a level of evidence of two and found that the effects of the intervention on nutrition depended on
school, grade, and age of the children. Whereas Greening et al., (2011) did a randomized control
trial with a level of evidence of one and found no evidence of differences in outcomes based on
gender, ethnicity, or race. A quasi-experimental study of New York, New York public
CHILDHOOD OBESITY 8
elementary schools and middle schools and the 1,065,562 students within those schools found
that the installation of more water fountains resulted in an overall increased water consumption
(Schwartz et al., 2016). Another study found that a school intervention of providing structured
meal and physical activity plans for students resulted in a decrease in occurrence of
hyperglycemia from 1% to 0% (Elizondo-Montemayor et al., 2013). A limitation to some of
these findings includes a lack of control group (Elizondo-Montemayor et al., 2013; Ling et al.,
2011; Schwartz et al., 2016). Other studies overcame this limitation by using a control group
(Greening et al., 2011; Lee et al., 2014).
Blood Pressure and Cholesterol. An intervention study of 96 children ages six through
twelve found that through a structured meal and physical activity plan created by the school, the
occurrence of metabolic syndrome fell significantly from 44% to 16%. The study also found that
high blood pressure fell from 19% to 0%. High-density lipoprotein-cholesterol also showed a
decrease in results with statistics decreasing from 60% to 41% (Elizondo-Montemayor et al.,
2013).
Attitudes and Psychosocial Outcomes. Studies examined the effects of school based
interventions on attitudes and psychosocial outcomes in children. Lee et al., (2010) found that
school based interventions lead to an improvement in attitudes toward exercise. Benjamins &
Whitman (2010) found in a school based intervention study that there was an increase in
knowledge of the importance of physical activity in the prevention of obesity among the students
who participated.
Family Based Interventions
Researchers have studied the effects of family based interventions in the prevention and
treatment of childhood obesity (Anderson et al., 2015; Brotman et al., 2012; Chen et al., 2015;
CHILDHOOD OBESITY 9
Davison et al., 2013; Fagg, et al., 2014; Jiang et al., 2005; Rodrigues et al., 2015; Sacher et al.,
2010; Steele et al., 2012; Teder et al., 2013; Watson et al., 2015). Families play an important role
in shaping children’s early life experiences (Davison et al., 2013). Many of children’s behaviors
are learned from their parents, thus parents serve as role models for their children’s behaviors.
Therefore, educating parents to be healthy role models may be helpful in the prevention and
treatment of childhood obesity (Chen et al., 2015). Of the articles studied, numerous effects were
found to result from using family based interventions including BMI; physical activity; nutrition
and dietary habits; blood pressure and cholesterol; and attitudes and psychosocial outcomes.
Body Mass Index. Several articles found effects on body mass index from the use of
family based interventions (Anderson et al., 2015; Brotman et al., 2012; Cao et al., 2015; Chen et
al., 2015; Davison et al., 2013; Fagg et al., 2014; Jiang et al., 2005; Sacher et al., 2010; Teder et
al., 2013; Watson et al., 2015). Many articles found that the use of family based interventions
was associated with statistically significant decreased BMI z-scores (Brotman et al., 2012; Cao et
al., 2015; Davison et al., 2013; Jiang et al., 2005; Sacher et al., 2010; Watson et al., 2015).
Sacher et al. (2010) found in a randomized control trial with a level of evidence of one, that a
family based intervention of educational and physical activity sessions along with a free family
swimming pass reduced both waist circumference and BMI z-scores. However, multiple articles
also concluded that there was no change in BMI after the implementation of family based
interventions (Anderson et al., 2015; Chen et al., 2015; Fagg et al., 2014; Teder et al., 2013). One
study relied on self-report for the BMI score, which may have biased the findings (Anderson et
al., 2015). A second limitation faced by multiple studies was a restricted sample size (Anderson
et al., 2015; Chen et al., 2015; Teder et al., 2013). Some studies also lacked a control group
(Anderson et al., 2015; Davison et al., 2013; Watson et al., 2015). Other studies overcame this
CHILDHOOD OBESITY 10
limitation by using both an intervention and control group in a randomized controlled study
(Brotman et al., 2012; Cao et al., 2015; Fagg et al., 2014; Jiang et al., 2005; Sacher et al., 2010).
Physical Activity. Multiple studies found positive effects of family based interventions
on levels of physical activity (Anderson et al., 2015; Brotman et al., 2012; Davison et al., 2013;
Rodrigues et al., 2015; Sacher et al., 2010; Teder et al., 2013). Studies found that children who
received family based interventions had statistically significant improvements in physical
activity levels (Anderson et al., 2015; Brotman et al., 2012; Davison et al., 2013; Sacher et al.,
2010; Teder et al., 2013). However, Rodrigues et al. (2015) found that physical activity alone
does not lead to weight loss, but needs to be combined with healthy eating habits to be effective.
Studies also found that children who received a family based intervention spent less time
watching television and engaged in screen time (Anderson et al., 2015; Brotman et al., 2012;
Davison et al., 2013; Sacher et al., 2010).
A limitation to some studies includes a setting not in the United States of America
(Rodrigues et al., 2015; Sacher et al., 2010; Teder et al., 2013). Some studies’ level of evidence
indicated a reduced reliability (Anderson et al., 2015; Davison et al., 2013; Rodrigues et al.,
2015; Teder et al., 2013) Other studies showed strong reliability through their level of evidence
and study methods (Brotman et al., 2012; Sacher et al., 2010).
Nutrition and Dietary Habits. Studies have found that the use of family based
interventions is associated with a change in nutrition and dietary habits (Anderson et al., 2015;
Brotman et al., 2012; Davison et al., 2013; Teder et al., 2013). Children who received family
based interventions had significantly lower total energy intake and macronutrient intake of fat,
protein, and carbohydrates compared to pre-family based intervention (Chen et al., 2016;
Davidson et al., 2013; Teder et al., 2013). Brotman et al. (2012) found in a randomized
controlled trial of 186 youth with a level of evidence of 1, that there were no significant
differences in total calories consumed between those who received a family based intervention
aimed at promoting effective parenting and those who were in the control group. However, the
study found significant differences in the proportion of calories consumed from carbohydrates,
protein, and fat. Those who received the family based intervention consumed fewer of their
calories from carbohydrates (Brotman et al., 2012). When family intervention was used, there
was also a noted decrease in the incidence of binge eating among children (Teder et al., 2013).
Another study found that children significantly increased their fruit and vegetable consumption
while decreasing their sugared beverage intake (Anderson et al., 2015). Rodrigues et al. (2015)
found that implementation of the Mediterranean diet, which is considered the current healthiest
diet, was effective in reducing childhood obesity. One limitation to these findings is that studies
relied on self-report (Davidson et al., 2013; Teder et al., 2013). Other studies overcame this
limitation by using study designs with higher levels of evidence (Anderson et al., 2015; Brotman
et al., 2012; Chen et al., 2015).
Blood Pressure and Cholesterol. A randomized control trial of 68 obese school aged
children found that after implementation of a two-year family based behavioral treatment
program that total cholesterol decreased by 5.5% and triglycerides by 9.7%. Blood pressure
readings were also found to be significantly decreased in those who received the family based
intervention (Brotman et al., 2012; Jiang et al., 2005). Both studies have a strong reliability with
a level of evidence of one.
Attitudes and Psychosocial Outcomes. Davison et al. (2013) in a pre and post-test
design found parents who received family based interventions reported significantly greater self-
efficacy to promote healthy eating in children and increased support for their children’s physical
activity in the post test. Studies found that children who received a family based intervention had
a higher rating of self-esteem compared to the control group (Fagg et al., 2014; Sacher et al.,
2010). Watson et al. (2015) found that there were only small improvements in all self-esteem
domains from baseline to post-family intervention. The only change to reach significance was in
the social acceptance domain. The study also found no significant differences in child outcomes
by gender or age (Watson et al., 2015). Steele et al., (2012) found that a child’s attitude of
readiness to change led to an overall more positive decisional balance related to health choices.
As a result, incidence of obesity in children decreased. However, this study also found that if
parents did not display the same attitude of readiness to change, then children were less likely to
have a positive attitude toward change and therefore did not see an improvement in their weight.
One limitation to these findings is that not all studies were conducted in the United States of
America (Fagg et al., 2014; Sacher et al., 2012). Another limitation in the study by Steele et al.
(2012) was a lack of racial and income level diversity among the studied population. This may
lead to difficulties applying the study conclusions to the general population.
Critical Appraisal of the Evidence
Due to the current rate of development of childhood obesity, it is important to review
studies on relevant prevention and remediation methods, and apply the most effective approach
to correcting this issue. If obesity is reduced and prevented early, it will decrease the likelihood
of numerous health issues later in life. Children will have a lesser chance of suffering from
problems such as diabetes, heart disease, and cancer if action is taken during childhood to
encourage and maintain a healthy lifestyle and BMI (Anderson et al., 2015). By preventing these
problems, there will be a decrease in the requirement of medical care for chronic conditions in
adulthood. Through investigation, this critical appraisal of evidence has produced several studies
dedicated to both family and school-based interventions and their effectiveness in preventing the
development of childhood obesity. Of the twenty studies reviewed in this appraisal, eight
focused on school-based intervention and twelve focused on family-based intervention.
Validity and Reliability of Findings and Methods for School Based Interventions
Many studies had a high level of validity and reliability. The validity and reliability of a
study can be established through the determination of the level of evidence. The level of
evidence is a system for rating evidence based on the effectiveness of a given intervention. For
this review, the rating system proposed by Burns, Rohrich, and Chung (2011) was used. Studies
are placed into a hierarchal rank based on the likelihood of bias in the study. Randomized
controlled trials are considered to be the highest level of evidence because of their intended
unbiased design, which leads to a reduced systematic error. Case series are considered to be the
lowest level because there is little to no control over interfering factors (Burns, Rohrich, &
Chung, 2011). The studies by Greening et al. (2011) and Cao et al. (2015) were a level of
evidence of one because they are both classified as randomized control trials. Three studies had
less validity and reliability with a level of evidence of two. These studies were considered a level
of two because two of the studies were quasi-experimental and one was an interventional study
(Ling et al., 2014; Rodrigues et al., 2015; Schwartz et al., 2016). The study by Cadzow et al.
(2015) had a level of evidence of three due to its classification as a three-year long longitudinal
cohort study that also lacked a control group. Three other studies had a level of evidence of four
(Benjamins & Whitman, 2010; Elizondo-Montemayor et al., 2013; Lee et al., 2014). These
studies were a level four because they are all intervention studies. The use of a control group
helped make two studies researching school based interventions more valid and reliable
(Greening et al., 2011; Rodrigues et al., 2015). In addition, a qualitative study was completed
and therefore had a level of evidence of six. This study consisted of research on barriers and
facilitators to the effectiveness of school based intervention programs (Greaney et al., 2014). Pre-
post interventions can cause many threats to internal validity (Benjamins & Whitman, 2010; Lee
et al., 2014). A small sample size also decreases the validity and reliability of two studies
(Elizondo-Montemayor et al., 2013; Greaney et al., 2014; Lee et al., 2014) The study conducted
by Lee et al. (2014) had a sample size of 106, while the study by Elizondo-Montemayor et al.
(2013) had a sample of 96, and Greaney et al. (2014) had 56 participants.
Validity and Reliability of Findings and Methods for Family Based Interventions
Four of the studies were a level of evidence of one evidence because they were
randomized controlled trials (Brotman et al., 2012; Fagg et al., 2014; Jiang et al., 2005; Sacher et
al., 2010). Two other types of studies used were a quasi-experimental design with a level of
evidence of two (Chen et al., 2015; Steele et al., 2012). One study was a level of evidence of
three because it was defined as an experimental cohort study (Anderson et al., 2015). Three
other studies had a level of evidence of four because the study by Davidson et al. (2013) is a pre-
post cohort study, the study by Watson et al. (2015) is a qualitative study with a pre-post design,
and the study by Teder et al. (2013) is a case-control observational study. Lack of control makes
four studies less valid and reliable (Anderson et al., 2015; Davison et al., 2013; Teder et al.,
2013; Watson et al., 2015). Pre-post interventions also decreased internal validity in two studies
(Davison et al., 2013; Watson et al., 2015). Self or parent reporting could result in response bias,
which occurred in two of the studies (Davison et al., 2013; Watson et al., 2015). A small sample
size also poses a threat to validity and reliability of eight studies (Anderson et al., 2015; Brotman
et al., 2012; Chen et al., 2015; Davison et al., 2013; Jiang et al., 2005; Sacher et al., 2010; Steele
et al., 2012; Teder et al., 2013).

Limitations of School Based Interventions
There were limitations found in the school based interventions studies. Three studies had
less reliability since they were not randomized controlled studies (Benjamins & Whitman, 2010;
Ling et al., 2014; Schwartz et al., 2016). For example, four studies had an intervention design
and one study was quasi-experimental (Benjamins & Whitman, 2010; Elizondo-Montemayor, et
al. 2013; Lee et al., 2014; Ling et al., 2014; Rodrigues et al., 2015). Four studies also lacked a
control group which decreased their reliability and validity (Benjamins & Whitman, 2010;
Cadzow et al., 2015; Elizondo-Montemayor et al. 2013; Ling et al., 2014). Another limitation
experienced by two studies was a limited setting and age group (Greening et al., 201; Lee et al.,
2014). For example, Ling et al. (2014) limited their study to just northern and central Kentucky
with children in grades kindergarten through fifth grade. Lack of diversity over socioeconomic
status and ethnicity was also a limitation found in four studies (Benjamins & Whitman, 2010;
Elizondo-Montemayor et al., 2013; Ling et al., 2014; Schwartz et al., 2016). For example,
Benjamins & Whitman (2010) based their study on two small Jewish schools in Chicago.
Another study looked at only Mexican children when implementing their interventions
(Elizondo-Montemayor et al., 2013). Small sample sizes were another limitation encountered in
three studies (Elizondo-Montemayor et al., 2013; Greaney et al., 2014; Lee et al., 2014). Another
limitation was the use of self or parent report, which may have biased the findings in three
studies (Benjamins & Whitman, 2010; Greening et al., 2011; Lee et al., 2014).
Limitations of Family Based Interventions
Limitations were found in the family based intervention studies. For example, six studies
were conducted outside of the United States of America (Cao et al., 2015; Chen et al., 2015;
Fagg et al., 2014; Jiang et al., 2005; Sacher et al., 2010; Teder et al., 2013). For example, one
study was conducted in two small cities in southeast Sweden (Teder et al., 2013). Another
limitation was a relatively short follow up, which limits long-term effects of the intervention in
three studies (Anderson et al., 2015; Chen et al., 2015; Sacher et al., 2010). A small sample size
was also a limitation in eight studies (Anderson et al., 2015; Brotman et al., 2012; Chen et al.,
2015; Davison et al., 2013; Jiang et al., 2005; Sacher et al., 2010; Steele et al., 2012; Teder et al.,
2013). A limited setting and age group was a limitation experienced as well in four studies
(Davison et al., 2013; Sacher et al., 2010; Steele et al., 2012; Watson et al., 2015). In addition,
the lack of a control group influenced the outcome of four studies (Anderson et al., 2015;
Davison et al., 2013; Teder et al., 2013; Watson et al., 2015). Another limitation was the absence
of a randomized sampling method in two studies (Chen et al., 2015; Davison et al., 2013) For
example, Chen et al. (2015) used convenience sampling and chose participating schools and
families based on their convenience to the research team. Another limitation was the use of self-
report in studies in two studies (Davison et al., 2013; Watson et al., 2015).
Synthesis of Evidence
Based on the findings above, many beneficial outcomes resulted from the use of family
and school based interventions. The interventions utilized in the studies can be incorporated into
practice and help healthcare professionals better care for children suffering from obesity and
provide effective treatment methods. For example, six family and three school based
interventions showed a statistically significant decrease in BMI z-scores (Brotman et al., 2012;
Cadzow et al., 2015; Cao et al., 2015; Davison et al., 2013; Jiang et al., 2005; Lee et al., 2014;
Sacher et al., 2010; Schwartz et al., 2016; Watson et al., 2015). However, four family based
intervention studies showed no change in BMI z-scores after family intervention (Anderson et
al., 2015; Chen et al., 2015; Fagg et al., 2014; Teder et al., 2013). This could be due to the
decreased validity and reliability of some of the studies (Anderson et al., 2015; Chen et al., 2015;
Teder et al., 2013) However, Fagg et al. (2014) was a randomized controlled trial with a level of
evidence of one adding good reliability and validity for that finding.
In five school based intervention studies and six family based intervention studies, there
was an increase in the level of physical activity among school aged children (Anderson et al.,
2015; Benjamins & Whitman, 2010; Brotman et al., 2012; Cadzow et al., 2015; Davison et al.,
2013; Elizondo-Montemayor et al., 2013; Greening et al., 2011; Ling et al., 2014; Rodrigues et
al., 2015; Sacher et al., 2010; Teder et al., 2013). Four studies including family based
intervention showed there was also a decrease in television screening time with an increased
activity level (Anderson et al., 2015; Brotman et al., 2015; Davison et al., 2013; Sacher et al.,
2010;). However, Rodriguez et al. (2015) found that physical activity alone does not lead to
weight loss, but needs to be combined with healthy eating habits as well.
There was an identifiable improvement in dietary habits and nutritional choices among
the children participating in the research in five school based studies and six family based studies
(Anderson et al., 2015; Brotman et al., 2012; Chen et al., 2016; Davison et al., 2013; Elizondo-
Montemayor et al., 2013; Greening et al., 2011; Lee et al., 2014; Ling et al., 2014; Rodrigues et
al., 2015; Schwartz et al., 2016; Teder et al., 2013). Three studies of family interventions also
found that there was a notable improvement in portion control used for family meals (Chen et al.,
2016; Davidson et al., 2013; Teder et al., 2013).
Blood pressure and cholesterol were also measured parameters in both school and family
intervention studies. In two family studies and one school intervention study, there was found to
be a decrease in blood pressure and cholesterol levels (Brotman et al., 2012; Elizondo-
Montemayor et al., 2013; Jiang et al., 2005).

Attitude and psychosocial outcomes were also measured in school and family
intervention studies. In two school based intervention studies and five family based intervention
studies there was found to be an improvement in attitudes toward exercising and an improvement
in self-esteem (Benjamin & Whitman, 2010; Davison et al., 2013; Fagg et al., 2014; Lee et al.,
2010; Sacher et al., 2010; Steele et al., 2012; Watson et al., 2015).
Recommendations
Application of Findings
Based on the findings above a definitive conclusion to determine if school or family
based interventions result in a more positive outcome cannot be drawn. It was found that both
school and family based interventions are beneficial in decreasing BMI, increasing physical
activity, improving nutrition and dietary habits, decreasing blood pressure and cholesterol, and
improving attitudes and psychosocial outcomes.
Recommendations for Further Research
None of the studies reviewed compared school versus family interventions in the same
study. Instead, the studies looked at either school or family based interventions and their
outcomes individually. Due to this lack of comparison within studies, further research is needed
to be completed. Research studies with a school and family intervention groups need to be
carried out in the future to better understand the relationship between the two. By having more
research comparing both intervention groups it can be better understood if family or school based
interventions are more effective at treating and preventing childhood obesity. Since childhood
obesity can lead to many adverse health complications, it is important to implement interventions
that can decrease the incidence and prevalence of childhood obesity. By conducting further
research, it is possible to advance nursing practice and help guide prevention and treatment of
childhood obesity. At this time, both interventions have proven to be successful to use in practice
to help guide childhood obesity treatment and prevention.
Conclusion
In summary, childhood obesity can lead to multiple chronic illnesses including diabetes,
cardiovascular disease, obstructive sleep apnea, nonalcoholic fatty liver disease, and an increased
likelihood of ischemic heart disease and breast cancer in adulthood (Anderson et al., 2015).
Childhood obesity is a prevalent problem affecting 155 million school age children and young
people globally (Kothandan, 2014). Early childhood is a crucial time to implement prevention
and treatment strategies since both family and school experiences are a large part of their lives.
By using the findings from the studies researched, interventions can be implemented to help
advance the prevention and treatment of childhood obesity. Although a conclusion cannot yet be
drawn as to whether school or family based interventions are more effective, it can be concluded
that both intervention methods have proven to have a positive impact on preventing and treating
childhood obesity. With further research on childhood obesity, advancement in childhood
obesity prevention and treatment can be made.

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APA formatted Background of Clinical Practice Design. Level of Evidence-based Practice & ****Limitations
reference[1] Clinical Setting. Evidence. Findings Research [1]
Problem. Population, Implications
Purpose Sampling
[1] Indicate if statement. methods, sample [1] Identify
primary or Research size. independent
secondary question[1]. variables,
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methods. statement and [1] List
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stated in article. validity and
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independent methods and
variables, applicability of
dependent findings.
variables, and Consider
population. strengths and
weaknesses of
study. [1]
Background- Setting- Intervention

Benjamins, M., There is a large Two jewish study The findings The current All outcomes
& Whitman, S. number of schools in showed several study was are based on
(2010). A school-based Chicago Level 4 significant completed in an self-report
culturally interventions increases in effort to respond
appropriate designed to Sampling student to the increasing No diversity in
school reduce method- knowledge, and need for participants-
wellness childhood Volunteer also an increase research on how Jewish children

initiative: obesity or in the percentage schools can best only
results of a 2- otherwise of older students work to prevent
year pilot promote health, regularly meeting and/or reduce
intervention in no models or physical activity childhood
2 Jewish materials were guidelines. Not obesity.
schools. found for Jewish many changes in
Journal Of schools. attitudes, other
School Health, behaviors, or
80(8), 378-386 environmental
9p. Purpose factors were
doi:10.1111/j.1 This study seen. More
746- describes the studies are
1561.2010.005 efforts within a needed to
17.x Jewish school determine how to
system to bring about
create, behavioral
implement, and changes, how to
evaluate a increase the
school-based sustainability of
intervention all of the
tailored to the changes, and how
unique to disseminate
characteristics of the model and
Jewish religion, products of this
culture, and intervention to
school other day
structures. schools.
Fagg, J., Background- Setting- Home Randomised BMI reduced by The MEND
Chadwick, P., Childhood setting control trial mean 0.76 kg m intervention, Study
Cole, T. J., overweight and 2 (s.e. = 0.021, P when delivered completed
Cummins, S., obesity is Population- Level- 1 o 0.0001), zBMI at scale, is outside of US
Goldstein, H., prevalent in Children between reduced by mean associated with
Lewis, H., & ... many countries 7 and 13 years 0.18 (s.e. = improved BMI
Law, C. and associated old who are 0.0038, P o and
(2014). From with poorer overweight or 0.0001), self- psychosocial
trial to physical and obese esteem score outcomes on
population: a psychosocial increased by 3.53 average, but
study of a health across the Sampling U (s.e. = 0.13, P may work less
family-based life course. method- o 0.0001) and well for some
community Volunteeer psychological groups of
intervention for Purpose- distress score children, and so
childhood To assess how Sample size- decreased by has the potential
overweight outcomes 21,503 2.65U (s.e.=0.31, to widen
implemented at associated with Po0.0001). inequalities in
scale. participation in a Generally, these outcomes.
International family-based outcomes Such public
Journal Of weight improved less health
Obesity, management among children interventions
38(10), 1343- intervention from less should be
1349 7p. (MEND 7–13, advantaged implemented to
doi:10.1038/ijo Mind, Exercise, backgrounds and achieve
.2014.103 Nutrition..Do in Asian sustained impact
it!) for compared with for all groups.

childhood white children.
overweight or
obesity vary by
child, family,
neighbourhood
and MEND
programme
characteristics.
Elizondo- Background- Setting- eight Design- Evidence based Implications- Limitations-

Montemayor, There is limited public schools in Interventional findings- A school setting This is the first
L., Gutierrez, evidence about Monterrey, study The lifestyle lifestyle
N. G., Moreno, effective Mexico. prevalence of intervention led intervention
D. M., strategies to Level of metabolic to a decreased with an
Martínez, U., manage Population- Evidence- 4 syndrome fell prevalence of individualized
Tamargo, D., childhood overweight/obese significantly being approach that
& Treviño, M. obesity and the children aged 6– from 44% to 16% overweight/obes has led to a
(2013). School- metabolic 12 years, who , high blood e and to a decrease in
based syndrome in were Mexican– pressure fell from reduction in the overweight/obes
individualised school settings Hispanic with a 19% to 0%, prevalence of ity and a
lifestyle low socio- hypertriglyceride the metabolic striking
intervention The study aimed economic status. mia fell from syndrome in a reduction in the
decreases to analyze 64% to 35%, sample of prevalence of
obesity and the changes in Sampling high-density Mexican the metabolic

metabolic weight status, Method- cross- lipoprotein- children. syndrome in 6–
syndrome in anthropometric sectional sample cholesterol 40 12 year-old
Mexican measurements, fell from 60% to Mexican
children. fasting glucose, Sample Size- 96 41%, children in a
Journal Of lipids, blood children hyperglycaemia school setting.
Human pressure and the fell from 1% to Also voluntary
Nutrition & prevalence of 0%, and waist participation in
Dietetics, the metabolic circumference ! the study and
2682-89 8p. syndrome 90th percentile the relatively
doi:10.1111/jh (MetS) and their fell from 72% to small sample
n.12070 connection to a 57%. There was a may have
10-month 2.84 significant influenced the
lifestyle decrease in body results, which
intervention, mass index may not be
based on percentile and in representative of
individualised body-fat the general
face-to-face percentage. Of population.
sessions and the overweight
parental support children, 32%
in a school- achieved normal-
setting. in weight, whereas
overweight and 24% of the obese
obese Mexican ones converted to
children aged 6– overweight and
12 years. 1% reached
normal-weight.
Lee, A., Ho, Background: Setting: 6 Hong Design: Findings: Implications: Limitations:
M., Keung, V. Home and Kong primary Intervention Students in the school based Unable to
W., & Kwong, school schools. study intervention weight determine if the
A. M. (2014). environments group reduced management environment
Childhood favorable for Population:overw Level of their BMI z-score programs component was
obesity unhealthy eating eight and obese Evidence: 4 and body fat integrated into a essential to
management and physical children ages 8- compared to the health success.
shifting from inactivity are 12 years old. control group promoting
health care precursors to with statistical school approach Small sample
system to obesity. Sampling significant. The appears to be a size
school system: Method: intervention promising
intervention Purpose Invitation letters group also had a practice for
study of Statement: to were sent to 65 significant sustaining Self
school-based study the primary schools reduction in BMI weight control. administered
weight effectiveness of participating in z-score and body questionnaire.
management a multi- Health Promoting fat after a 4
programme. component School (HPS). month
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71-2458-14- program for of obesity, An Improvement
1128 overweight and children in the in dietary habits
obese primary school, school and positive
school children. district, readiness attitudes towards
Primary of the school, and exercise were
similarity in observed among
Quantitative socio- the intervention
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background
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program.
Sample Size: 106

with 57 in the
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Greaney, M. Background- Setting- Design- Findings- Implications- Limitations-

L., Hardwick, Schools are a 10 Healthy Qualitative Study State-mandated Results confirm It was designed
C. K., strategic Choices-II testing, budget the importance as an in-depth
Spadano- organizational program Level VI limitations, and of gaining exploration of
Gasbarro, J. L., setting for participating time constraints faculty and staff the process of
Mezgebu, S., obesity schools. were viewed as support. Schools implementing
Horan, C. M., prevention, but implementation implementing Health Choices;
Schlotterbeck, school-based Population- barriers, whereas large-scale thus, results are
S., & ... interventions middle school staff buy-in, interventions not
Peterson, K. E. addressing administrators or external support, should consider generalizable.
(2014). lifestyle employees and technical developing Interviews were
Implementing behaviors to involved in assistance were sustainable conducted at 1
a prevent obesity implementation seen as partnerships time point,
Multicompone have had mixed of Healthy facilitating with during the third
nt School- success,3,4 Choices-II implementation. organizations year of the
Based Obesity which has led to program that can provide intervention,
Prevention calls for resources and rather than at
Intervention: A comprehensive Sampling ongoing several points
Qualitative approaches to method- training. throughout the
Study. Journal obesity Individual intervention
Of Nutrition prevention that schools were period. In
Education & address multiple contacted based addition, the
Behavior, levels in schools on their use of the researchers used

46(6), 576-582 or in afterschool Healthy Choices- purposive
7p. settings. II program and sampling;
doi:10.1016/j.j the number of individuals
neb.2014.04.29 Purpose students involved identified by
3 statement- with the program school
The purpose of at the school. coordinators as
this case study Once schools potential
was to use agreed to participants may
qualitative voluntary have been more
research participation in invested in the
methods to the study, intervention
explore barriers administrators than those who
and facilitators identified proper were not
to implementing employees for approached. The
and maintaining interviews. authors were
a also unable to
multicomponent Sample Size- 56 conduct all
school- based interview planned
intervention. participants interviews.
Ling, J., King, Background: Setting: Four K-5 Design: quasi- Findings: The Implications: Limitations:
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B. J., Kim, S., obesity has schools in north design significant effects suggest that experimental
& Wu, D. become a and central on increasing the school design is not as
(2014). national public Kentucky. Level of percentages of authorities and reliable as a
Preliminary health crisis in Evidence: Level children meeting classroom randomized
assessment of a America. School Population: 2 physical activity teachers should controlled trial.
school-based based healthy children in grades and nutrition consider
healthy lifestyle K-5 in northern recommendations incorporating Lack of control
lifestyle interventions and central . The effects of nutrition, group.
intervention play a promising Kentucky. the intervention physical Lack of control

among rural role in on physical activity, and over other
elementary preventing and Sampling activity and health messages factors such as
school treating methods: All nutrition into school socioeconomic
children. childhood children in these depended on curricula and status and
Journal Of obesity. four elementary school, grade, aligning school ethnicity.
School Health, schools were and age of the wellness
84(4), 247-255. Purpose. To included. children. There policies with the BMI, waist
Retrieved from assess the effects was an increasing Healthier US circumstance, or
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Hsu, S. (2015). international City, Taiwan control group did d with the size
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a Family- School nurses in Population- significantly in the experimental Study
Based Taiwan are in Overweight or the outcome group reported a completed
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among 55 in control that an FB
overweight/obes group (107) program can
e children (age influence the
9–11 years) and behaviors of
their parents in parents during
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School-Based have been Level III decreased control not known

Obesity shown to Population- significantly population whether other
Intervention decrease intake Children in from 70.4 to 65.7 however they students in this
Associated of non- grades 3-12 %.. This exceeds indicate that a same region also
with Three nutritional the change in three year experienced
Year Decrease foods, increase Sampling BMI percentile multilevel decreases in
in Student student physical Method- All seen at the school-based BMI percentile
Weight Status activity and students present national level. intervention over this same
in a Low- educate students at school on days There was a involving time period.
Income School about healthy of data collection significant physical activity Also, a
District. food choices but decrease in the and nutritional multifaceted
Journal Of relatively few Sample Size- proportion of changes was approach, while
Community have shown cohort of 2,259 students correlated with considered
Health, 40(4), long-term students who had categorized as improved advantageous
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doi:10.1007/s1 weight status (2007) and obese. among most impact,
0900-015- endpoint (2010) participating makes it
9989-0 Purpose data school children. difficult to
Statement- measurements. 39 determine which
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this study was to students (grades intervention
evaluate the 3–5), 38 % contributed
effects of the middle school most to its
changes related students (grades success. Time
to the 6–8), and 23 % and funding did
obtainment of high school not allow for
the U.S. students (grades phasing in of
Department of 9–12) in 2007. intervention
Education Carol The study sample components to
M. White is 51 % female measure them
Physical and 89 % non- individually.
Education Hispanic white
Program Grant which is
(PEP) funds. representative of

Changes the overall
included student
physical population.
education
equipment and
curriculum and
offered access to
equipment and
activities outside
of school hours.
There were also
changes to
school food and
health education
curriculum.
Greening L., Background: Setting: Design: Findings: Implications: Limitations:

Harrell K.T., Obesity is linked Mississippi randomized students who School-based Use of self-
Low A.K., to some of the control trial participated interventions and/or parent-
Fielder C.E. leading causes Population: in monthly designed to report measures
(2011). of morbidity and school aged Level of physical activity instill healthy for physical
Efficacy of a early mortality. children ranging evidence: 1 and nutritional lifestyle activity and
from 6-10 years events during the behaviors by
school-based dietary fat
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childhood Purpose: to of age. intake.
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group) showed
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rural southern based childhood were randomly physical under scrutiny
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TEAM intervention intervention and percentage body be a solution for
Mississippi program in a control fat, physical preventing
Project. state where the conditions. activity, childhood
Obesity, rate of obesity is performance on obesity since

19(6):1213- the highest in Sample Size: 450 fitness tests, and children in this
1219. the nation- children (204 dietary habits study showed a
Retrieved Mississippi. attended the compared to the statistically
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Background: the Setting: London, Design: Parents and Implications: Limitations:

Sacher P.M., recent rise in the UK. Randomized children in the participation in Lack of blinding
Kolotourou M., prevalence of control trial intervention the MEND for
Chadwick childhood Population: group (who Program was measurement of
P.M., Cole obesity is a Children Level of attended eighteen effective in outcomes.
T.J., Lawsonet evidence: 1 2-h group reducing
major public were educational and
M.S., … health issue. The eligible if adiposity in Selective
physical children and
Singhal, A. short and long dropout may
they were activity sessions effects were sus-
(2010) term effects held twice have influenced
Randomized obese (BMI ≥ tained 9 months the results.
including a weekly in sports
controlled trial potential 98th after the
centers and
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schools, followed
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intervention for have made the comorbidities, had a reduced of the few Not conducted
childhood prevention and physical waist pediatric obesity in the USA

obesity. treatment of disabilities, or circumference z- interventions
Obesity, 18 (1), childhood learning score and BMI z- which conforms
S62- S68. obesity a difficulties, score at 6 to expert
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pass. Sampling reduced their
Method: Potential waist and BMI z-
subjects were scores by 0.47
recruited from and
five UK sites by 0.23 respectively,
referrals from and benefits in
local health cardiovascular
professionals fitness, physical
(dieticians, activity levels,
school nurses, and self-esteem
and general were
practitioners), or sustained. High-
were self-referred attendance rates
suggest that
families found
Sample Size: 116 this intensive
children: 60 to community-based
the intervention intervention
group and 54 to acceptable.
the control group.
Brotman L.M., Background: Setting: ten USA Design: Results: Implications: Limitations:
Dawson- The rates of elementary Randomized Youth Early
McClure S., overweight have schools control trial randomized to intervention that Randomized
Huang K.Y., doubled among the family promotes control trials
Theise, R., 2-5 year olds Population:minor Level of intervention effective were not
Kamboukos, over the past ity youth at risk Evidence: 1 aimed to promote parenting in designed for the
D. Wang, J. three decades. for behavior effective children at high purpose of
(2012). Early Overweight problems parenting and risk is a evaluating
childhood preschool prevent behavior promising physical health
family children are five Sampling problems group approach to outcomes.
intervention times more Method: Random had significantly obesity Small sample
and long-term likely to be lower BMI at prevention. size.
obesity obese at age 12 Sample Size: 186 follow-up
prevention than non- relative to
among high- overweight controls. Clinical
risk minority children. impact is
youth. Childhood evidenced by
Pediatrics, obesity is a lower rates of
129(3):E621- costly public obesity among
E628. health problem intervention girls
Retrieved from which is and boys relative
http://pediatrics associated with to controls There
.aappublication an increased were significant
s.org/content/1 incidence of intervention-
29/3/e621 hypertension control group
and diabetes. differences on

Children with physical and
behavior sedentary
problems, such activity, blood
as impulsivity, pressure, and
or a family diet.
history of
behavior Two long-term
problems are at follow-up studies
increased risk of randomized
for poor health, trials show that
including relative to
obesity controls, youth at
risk for behavior
Purpose: to test problems who
the hypothesis received family
that family intervention at
intervention to age 4 had lower
promote BMI and
effective improved health
parenting in behaviors as they
early childhood approached
affects obesity in adolescence.
preadolescence.
Davison, K. K., Background:Inef Setting:five Head Design: Pre-Post Findings: Implications: Limitations:
Jurkowski, J. fective family Start centers in cohort Children at post
M., Li, K., interventions to upstate New intervention Empowering The level of
Kranz, S., & help prevent York. Level of (parents parents to play evidence is not
Lawson, H. A. childhood Evidence: 4 implemented an equal role in as reliable as it
(2013). A obesity have in Population: revisions to intervention could be.
childhood part been Parents and their letters sent home design and
obesity attributed to the children 2-5 year to families implementation Small sample
intervention challenges of olds in Head Start reporting child is a promising size restricted to
developed by reaching and centers. body mass index; approach to one area.
families for engaging (2) a family-centered
families: parents. Sampling communication obesity Lack of control
results from a Methods: Parents campaign to raise prevention group.
pilot study. Purpose: to of Head Start parents’
International evaluate the children, who awareness of Pre-post
Journal Of effectiveness of comprised the their child’s interventions
Behavioral a parent- majority of the weight status; (3) can reflect a
Nutrition & centered community the integration of number of
Physical community advisory board, nutrition threats to
Activity, 101- based were recruited counseling into internal validity.
11 11p. participatory through the Head Head Start family
doi:10.1186/14 research Start Policy engagement Parent reporting
79-5868-10-3 approach for Council and word activities; and (4) could result in
obesity of mouth by a 6-week parent- response bias.
prevention in organizational led program to
vulnerable staff, the Policy strengthen
families. Council parents, parents’
and the project communication
coordinator skills, conflict
resolution,
Sample Size: 423 resource-related
children and their empowerment for
families were healthy lifestyles,
exposed to the social networks,
intervention and and media
154 families literacy)
participated in its exhibited
evaluation significant
improvements in
their rate of
obesity, light
physical activity,
daily TV
viewing, and
dietary intake
(energy and
macronutrient
intake). Trends
were observed
for BMI z-score,
sedentary activity
and moderate
activity. Parents
at post
intervention
reported
significantly
greater self-
efficacy to
promote healthy
eating in children
and increased
support for
children’s
physical activity.
Watson, P. M., Background: Setting: Design: Single- Results: Implications: Limitations:

Dugdill, L., Children who Community group repeated Child BMI z- This study lack of control
Pickering, K., are obese face venues in a measures with score reduced by shows the group
Owen, S., psychological socioeconomicall qualitative 0.07 from GOALS
Hargreaves, J., and physical y deprived, urban questionnaires. baseline to post- childhood The pre–post
Staniford, L. J., health location in the Pre-post design intervention and obesity design provides
& ... Cable, N. complications in north west of was maintained treatment no information
T. (2015). the short term England Level of at 12 months. intervention about how
Service and are more Evidence: Level There was no supported children's BMI
evaluation of likely to become Population: 4 change in families to z-scores might
the GOALS obese adults. overweight or parent/carer BMI change their have changed
family-based Since adult obese children or child self- physical activity without
childhood obesity is a risk and their perceptions, other and dietary intervention
obesity factor for parents/caregiver than an increase behaviors, High attrition
treatment lifestyle-related s who completed in perceived resulting in rate
intervention morbidity and GOALs between social acceptance small
during the first mortality, it is September 2006 from baseline to improvements Not as reliable
3 years of important to and March 2009. post-intervention. to children's as a randomized
implementation develop Parents/carers BMI z-scores. controlled trial.
.BMJ Open, effective Sampling reported positive
5(2), e006519. interventions for Method: All changes to family
doi:10.1136/b treating obesity families attending physical activity
mjopen-2014- in childhood. GOALS between and dietary
006519 Parents play a September 2006 behaviors after
key role in and March 2009 completing
children's were invited to GOALS.
physical activity take part in the
and dietary study.
behaviors.
Therefore in Sample Size: 143
order for families
children who are
overweight to
make healthy
changes to their
physical activity
and diet,
changes may
also be required
in their parents
weight-related
cognitions and
behaviours.
Purpose:to
evaluate a
community-
based childhood
obesity
treatment
intervention
Getting Our
Active
Lifestyles
Started
(GOALS) that
drew on social
cognitive theory
to encourage
healthy lifestyle
changes for the
whole family.
Cao, Z., Wang, Background- Fourteen primary Design- The overall The family- Study conducted
S., & Chen, Y. Family and schools were randomized prevalence of individual- outside of US
(2015). A school-based selected from 26 control trial overweight/obesit school–based
randomized interventions for primary schools y declined from comprehensive
trial of multiple childhood in a district of level-1 28.92% in 2011 intervention
interventions obesity have Shanghai, China, to 24.77% in model is
for childhood been widely and then 2014, with a effective for
obesity in applied; randomly divided difference of controlling
China. however, the into intervention 4.15% in the childhood
American prevalence of and control intervention obesity and
Journal Of childhood groups with group compared overweight.
Preventive obesity remains seven schools in with a 0.03%

Medicine, high. each. The trial decline (from
48(5), 552-560 started with first- 30.71% to
9p. grade students. 30.68%) in the
doi:10.1016/j.a control group.
mepre.2014.12. Purpose- To The intervention
014 evaluate the Sample- 1,287 group had
effectiveness of students in the significantly
a family- intervention lower odds of
individual- group and 1,159 developing
school–based in the control obesity or
comprehensive group overweight and
intervention had decreased
model. average BMI z-
scores compared
with the control
group, especially
for obese or
overweight
students.
Jiang, J., Xia, Background- Setting- single Design- random Body mass index A family based
X., Greiner, T., Childhood school and controlled trial (BMI, kg/m2) behavioural
Lian, G., & obesity has Beijing was significantly intervention was Study
Rosenqvist, U. become a Level - 1 reduced in the feasible to use completed
(2005). A two nutritional Population- obese treatment group in treating outside of US
year family problem in school children (from 26.6 (1.7) obesity in
based China since the grades 7-9 to 24.0 (0.9), schoolchildren
behaviour 1990s. 95% CI 2.06 to in Beijing,
treatment for Sampling 3.18) but not in China. After
obese children. Purpose- A method- random the control group two years of
Archives Of family based assignment (from 26.1 (1.5) implementation,
Disease In behavioural to 26.0 (1.6)). it successfully
Childhood, treatment plan Sample size- 33 Total cholesterol decreased the

90(12), 1235- was developed in treatment decreased 5.5% degree of
1238 4p. and tested to see group, 35 in and triglycerides obesity, reduced
if its use was control group 9.7% in the levels of blood
feasible in China treatment group. pressure, and
and to evaluate There was a decreased serum
its impact on significant lipids in
obese correlation treatment; there
schoolchildren. between change were no
in BMI and significant
change in changes among
triglycerides. control children.
There were no
significant
changes in
plasma lipids in
the controls.
Blood pressure
values also
decreased
significantly in
the treatment, but
not the control
group.
Steele, M. M., Background: Population: Design: Evidence-based Research Limitations:

Steele, R. G., Despite the families enrolled quasiexpermental Findings: Implications: The restricted
& Cushing, C. potential for in a 10-week, Children The results of ethnic and racial
C. (2012). understanding family-based Level of evidenced a more this study diversity, and
Weighing the readiness to weight loss Evidence.: positive emphasize the relatively high
Pros and Cons change in the program. Level II decisional important role a income level,
in Family- context of Families with balance profile child’s readiness within the
Based Pediatric weight children between than their parents to change can sample can be
Obesity management, the ages of 7 and at pre- play in the seen as a
Intervention: few studies have 18 years, who intervention. treatment of potential issue
Parent and examined had at least one Child pre- pediatric that could limit
Child decisional parent willing to intervention obesity. the
Decisional balance of participate in the weight status was generalizability
Balance as a lifestyle changes program, and a associated with of these
Predictor of within the child with a BMI child decisional findings.
Child family as an above the 85th balance, but not
Outcomes. indicator of percentile for parent decisional Simply
Children's readiness to their age and balance. Finally, weighing the
Health Care, change in this gender were child total advantages and
41(1), 43-55 context. included in the decisional disadvantages of
13p. study. balance was the engaging in
doi:10.1080/02 Purpose single best specific weight
739615.2012.6 Statement: Sampling predictor of child loss behaviors is
45726 This study was methods: outcomes not the
designed to Volunteer responsible
advance the mechanism for
following three Sample size. actual weight
discrete aims 37 participant loss.
related to the
understanding of
the decisional
balance in the
context of a
pediatric weight
management
intervention:
describe the
relation between
parent and child
decisional
balance profiles
and pre-
intervention
weight status,
examine the
relation between
parent and child
decisional
balance profiles,
and examine the
impact of parent
and child
decisional
balance profiles
on child weight
posttreatment.
Anderson, J. Background: Setting: Design: Evidence based Conclusion: Limitation:

D., Newby, R., Primary care Two Minneapolis Experimental findings: This family- The small
Kehm, R., providers play a Park and Cohort study Adults and focused sample size
Barland, P., & pivotal role in Recreation children were childhood affects our
Hearst, M. O. identifying and Community Level of largely Hispanic/ obesity ability to detect
(2015). Taking managing Centers in low- Evidence: Latino and low- intervention significant
Steps childhood income, Level III income. Adults integrated changes in
Together: A obesity, yet they multiethnic and children evidence-based health- related
Family- and face challenges communities in significantly principles with a behaviors and
Community- that restrict their Minneapolis, increased their non prescriptive also reduces the
Based Obesity ability to help Minnesota. fruit and approach and generalizability
Intervention patients make vegetable produced of the results.
for Urban, key obesity- Population: consumption and significant Only a third of
Multiethnic related Families weekly physical improvements the participants
Children. behavioral with at least activity, and in key healthy completed the
Health changes in a adults behaviors for intervention,
Education & clinic setting. one child significantly both adults and with those who
Behavior, between the decreased children. left citing
42(2), 194-201 Purpose sugared beverage barriers such as
ages 7 and 17
8p. statement: consumption and scheduling
with a BMI%
doi:10.1177/10 Taking Steps screen time. No conflicts and
901981145478 Together’s ≥85% and change in body transportation
13 approach fluency in mass index was difficulties
emphasized English or observed for
building self- Spanish. adults or Without a
efficacy, children. randomized
targeting both Sample Method: control group,
children and the program we are limited
parents for allowed rolling in our ability to
healthy change, enrollment with assert that the
and fostering families healthy changes
intrinsic completing the made by
motivation for entire curriculum participants
healthier living. but graduating at were a direct
The hypothesis different times. In result of the
of the study is response to intervention and
that a childhood participant not, in part, due
obesity feedback, to a greater
intervention enrollment was degree of
utilizing these subsequently motivation for
strategies will be changed to a health
efficacious in cohort model improvements.
helping families with six cohorts
achieve the of families
evidence-based starting and
healthy completing the
behaviors. 16-week program
together at two
program sites
Sample Size:
Sample Size
varies based on
the number of
participants that
fit criteria for
each variable
measured.
Teder, M., Background: Setting: Design; Evidence Based Conclusion: Limitations:

Mörelius, E., Family-based Two Case-Controlled Findings: Child and parent The single-
Nordwall, M., behavioural municipalities in Observational According to reports of group design,
Bolme, P., intervention southeast Sweden study both children's physical activity having as
Ekberg, J., programs and parents' were found to consequence
Wilhelm, E., & (FBIPs) against Population: Level: IV reports, the level converge and that it is not
Timpka, T. childhood Children ages 8- of physical display an possible to
(2013). obesity have 12 years and their activity among improvement in distinguish
Family-Based shown parents the children had a 2-year FBIP, between FBIP
Behavioural promising increased after while the reports effects and
Intervention results, but the Sample method: the intervention on eating habits normal
Program for mediating as well as the showed a more cognitive and
Obese mechanisms Sample size: agreement refractory behavioural
Children: An have not been Twenty-six between the pattern. Changes maturation and
Observational identified. children, 14 boys informants' in concordance development in
Study of Child and 12 girls, and reports. and agreement childhood. The
and Parent Purpose their parents were According to the between items used for
Lifestyle statement: included. children, eating children and lifestyle
Interpretations. The aim of this habits had parents reports assessments
Plos ONE, study was to improved, while did not correlate during the
8(8), 1-8. examine the parents' with weight treatment
doi:10.1371/jo changes in obese reports showed reduction. process were
urnal.pone.007 childreńs an improvement Further methods derived from the
1482 lifestyle habits only with regard development manual for

during a 2-year to binge eating. and studies of tutor-supervised
FBIP according The concordance the processes group sessions
to their own and between children during family- used for the
parents’ reports, and parents based FBIP, and the
the concordance regarding eating interventions data were used
between these habits was slight against in the
reports and the to fair also after childhood intervention
correlations to the intervention. obesity are process.
change in post- No statistically warranted.
intervention significant
BMI. associations
between changes
in lifestyle
reports and
changes in BMI
were observed.
Schwartz, A. Background: Setting: Design: Evidence based Results: Limitations:

E., Leardo, M., Decreasing the 227 New York, Quasi- findings: Results from Limited socio
Aneja, S., & amount of New York, public experimental There was a this study show economic
Elbel, B. caloric elementary significant effect an association diversity due to
(2016). Effect beverages schools and Level of of water jets on between a schools studied
of a School- consumed and middle schools Evidence: standardized relatively low- all being
Based Water simultaneously Level II BMI, such that cost water selected from
Intervention on increasing water Population: the adoption of availability the same
Child Body consumption is Elementary and water jets was intervention and geographic area.
Mass Index important to middle school associated with a decreased Not randomized
and Obesity. promoting child students 0.025 reduction student weight. control study.
JAMA health and of standardized Additional
Pediatrics, decreasing the Sample method: BMI for boys and research is
170(3), 220- prevalence of a 0.022 reduction needed to
226 7p. childhood Sample size: of standardized examine
doi:10.1001/ja obesity. 1 065 562 BMI for girls. potential

mapediatrics.2 students within There was also a mechanisms for
015.3778 Purpose studied schools. significant effect decreased
statement: on being student weight,
To estimate the overweight. including
impact of water Water jets were reduced milk
jets (electrically associated with a taking, as well
cooled, large 0.9 percentage as assessing
clear jugs with a point reduction in impacts on
push lever for the likelihood of longer-term
fast dispensing) being overweight outcomes.
on standardized for boys and a
body mass 0.6 percentage
index, reduction in the
overweight, and likelihood of
obesity in being overweight
elementary for girls. We also
school and found a 12.3
middle school decrease in the
students. number of all
types of milk
half-pints
purchased per
student per year.
Marques Background- Setting- Design- The prevalence The prevalence Study

Rodrigues, A., The etiology of School Intervention of overweight of obesity was completed in
Azevedo childhood study was high high in children one single
Alves, O. M., obesity is Population- throughout the of the different community
& Elsa Cristina multifactorial students Level- 2 schools years. age groups who setting outside
Barreto Lima but thought to be turning six years However, were subjected of US
Freitas, A. primarily an old who were overweight to the childhood
(2015). Impact inappropriate enrolled in children who obesity

of the and unbalanced primary schools were subjected to intervention
Childhood diet and of the Cluster of an project during a
Obesity sedentarism. Schools of Ponte individual/family 4-year period. It
Intervention da Barca intervention was concluded
Project on Purpose- became normal- that the problem
primary school To assess Size- 381 weight. The of overweight
children from a the impact of the children levels of physical and obesity
cluster of project on the activity were low remains.
schools. prevalence of and the optimal
Revista De childhood Mediterranean
Enfermagem obesity, eating Diet was
Referência, (5), habits and predominant. As
57-64 8p. physical activity regards the focus
doi:10.12707/R in children groups,
IV14062 turning six by perceptions
the end of each related to project
year. development
emerged.

Effectiveness of School-Based Interventions Versus Family-Based I

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Effectiveness of School-Based Interventions Versus Family-Based I

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The University of Akron

Effectiveness of School-based Interventions versus

Effectiveness of School-based Interventions versus Family-based Interventions in the Prevention

and Treatment of Childhood Obesity

Ashley Capestrain, Meghan Frantz, Emily Montague

The University of Akron

Heifner Graor, PhD, MSN, APMHCNS-BC, RN

Childhood obesity affects 155 million children worldwide. As prevalence increases, it is

in the prevention and treatment of childhood obesity.

There is an increasing prevalence of childhood obesity throughout the world. It affects

prevention based on children’s developmental patterns, including stabilization of health

decrease the prevalence of obesity in children.

recommendations for practice and research are made.

randomized control trials, intervention studies, qualitative studies, quasi-experimental designs, a

(2011) was used.

A for the breakdown of searched articles.

School Based Interventions

psychosocial outcomes. Each effect is discussed in depth below.

based intervention may be attributed to confounding factors such as the environment,

above the 85th percentile in children.

intervention led to a statistically significant increase in performance on physical activity tests

did not receive the school based intervention.

hyperglycemia from 1% to 0% (Elizondo-Montemayor et al., 2013). A limitation to some of

(Greening et al., 2011; Lee et al., 2014).

Family Based Interventions

received family based interventions had statistically significant improvements in physical

Davison et al., 2013; Sacher et al., 2010).

and study methods (Brotman et al., 2012; Sacher et al., 2010).

et al., 2012; Chen et al., 2015).

a level of evidence of one.

lead to difficulties applying the study conclusions to the general population.

Critical Appraisal of the Evidence

Due to the current rate of development of childhood obesity, it is important to review

focused on school-based intervention and twelve focused on family-based intervention.

et al., 2012; Teder et al., 2013).

Limitations of School Based Interventions

Limitations of Family Based Interventions

2016; Davidson et al., 2013; Teder et al., 2013).

Montemayor et al., 2013; Jiang et al., 2005).

Based on the findings above a definitive conclusion to determine if school or family

improving attitudes and psychosocial outcomes.

Recommendations for Further Research

to help guide childhood obesity treatment and prevention.

childhood obesity. With further research on childhood obesity, advancement in childhood

obesity prevention and treatment can be made.

together: a family- and community-based obesity intervention for urban, multiethnic

children. Health Education & Behavior, 42(2), 194-201. doi:10.1177/1090198114547813

results of a 2-year pilot intervention in 2 Jewish schools. Journal Of School Health,

80(8), 378-386. doi:10.1111/j.1746-1561.2010.00517.x

high-risk minority youth. Pediatrics, 129(3), E621- E628. Retrieved from

in evidence-based medicine. Retrieved from

district. Journal Of Community Health, 40(4), 709-713. doi:10.1007/s10900-015-9989-0

Calculate your body mass index. (2016). Retrieved from https://www.nhlbi.nih.gov/health/

childhood obesity in China. American Journal Of Preventive Medicine, 48(5), 552-560.

International Journal Of Behavioral Nutrition & Physical Activity, 101-111.

Defining Childhood Obesity. (2015). Retrieved from

Treviño, M. (2013). School-based individualized lifestyle intervention decreases obesity

Dietetics, 2682-289. doi:10.1111/jhn.12070

From trial to population: A study of a family-based community intervention for

childhood overweight implemented at scale. International Journal Of Obesity, 38(10),

Schlotterbeck, S., & ... Peterson, K. E. (2014). Implementing a multicomponent school-

based obesity prevention intervention: a qualitative study. Journal Of Nutrition

Education & Behavior, 46(6), 576-582 7p. doi:10.1016/j.jneb.2014.04.293

doi:10.1001/ja obesity. 1 065 562 BMI for girls. potential