Opinion

Can schools be expected to solve the obesity crisis?

21 Oct 2019, 5:15

PE and sport premium

Setting aside the moral question as to whether this is what schools should be doing, how easy is it to actually make a difference? A school’s core activities are difficult enough. Where activities are, arguably, tangential to that core, the challenges may be even greater.

Schools are often seen as the first line of defence against many of society’s problems. When a new issue arises, the knee-jerk reaction often is that “schools should be doing more”. Take rising obesity and the need to improve activity levels and reduce waistlines. Two recently published studies (one aimed at reducing obesity in primary, the other increasing activity levels in secondary) illustrate the problem.

The first is a randomised controlled trial of the West Midlands Active Lifestyle and Healthy Eating in School Children (WAVES) intervention*. This involved almost 1,500 five and six-year-olds from 54 primary schools, and was by no means light touch. Lasting for 12 months, it included:

  • 30 minutes of additional moderate-to-vigorous physical activity (MVPA) on each school day;
  • termly cooking workshops during school time, when parents were invited to learn with their children;
  • a six-week programme to encourage healthy eating and increase physical vitality, delivered by the local professional football club;
  • information sheets supporting children and their families to be active over the summer.

Making a difference to these issues requires wider community involvement

Children’s measurements – including weight, height, percentage body fat, waist circumference, skinfold thickness and blood pressure – were taken when they started the trial and again 15 months and 30 months later. They were then compared with children in a control group.

At the first follow-up, the mean body mass index (BMI) score was not significantly lower for the intervention group compared with the control. At 30 months, the mean difference was smaller and remained non-significant. This intervention, then, was not successful in bringing about an improvement in young children’s weight – and presumably not in their overall routines of activity and eating.

Children become less active as they grow older, so might an approach in secondary school prove more effective? A recent study looked at the impact of Girls Active**, a programme developed by the Youth Sport Trust that provides a support framework to schools to review their physical activity, sport, and PE teaching to ensure they are relevant and attractive to all adolescent girls. It has a particular focus on 11 to 14-year-olds.

Twenty secondary schools in the Midlands participated in the trial, with ten schools receiving Girls Active and ten schools continuing with usual practice. In total, 1,752 girls aged 11 to 14 took part. The primary outcome measure (at the start, seven months, and 14 months) was MVPA, recorded on wrist-worn accelerometers. Secondary outcomes included overall physical activity, light physical activity, sedentary time, body composition, and psychosocial outcomes.

The results showed small improvements in MVPA compared with control schools after seven months, but none after 14 months. Interestingly the subgroup analysis showed that the intervention was effective at 14 months in larger schools, but caused an MVPA decrease in smaller schools. (Perhaps larger schools had the capacity to run the programme effectively, while in smaller schools it was more distracting than helpful.) There was no pattern in the secondary outcomes, and any differences were slight.

Of course these are just two studies, but both were disappointing, despite requiring substantial resources. It suggests that making a difference to these issues requires wider community involvement – not surprising, given that they are issues affected by what is occurring in the wider society, rather than in schools alone.

For schools, it is a reminder that investment in addressing these issues may not necessarily result in improvement. Reviewing the evidence of what has worked (or not) in the past is a vital first step before taking any action. Limited resources mean it is important to choose the right priorities. Shifting the dial on a particular issue takes effort, and you can’t focus on everything.

 

References:

* Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study) (February 2018), BMJ 2018; 360:k211

** Effectiveness of the “Girls Active” school-based physical activity programme: A cluster randomised controlled trial (April 2018) International Journal of Behavioral Nutrition and Physical Activity



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8 Comments

  1. I continue to be surprised that obesity is still seen as a physiological condition by many. The PE and school sport quangos will always promote themselves as the people to transform the health of the next generation but statistics suggest that investing health funding through a filter of PE & SS will have no positive impact.

    At Evolve, through Project HERO (Health Engagement Real Outcomes), we aim to support schools to raise healthier, happier and smarter kids to perform better in school and beyond into life. HERO gives focus to physical, emotional and cognitive health underlining our belief that health should be via preventative, holistic interventions and not in isolation (such as obesity or mental health).

    Graham Morgan

  2. Evolve believes health and education should come together in schools and that education will have a greater impact on health than just exercise or diet specifically. Health is more important than PE or Sport and as such Health should be a given priority in the curriculum.

    Schools should be the battleground toly the foundation for healthier lives but teachers are not the soldiers to carry the fight as their prioritites, training and enthusiasm is to be found elsewhere.

    Evolve Health Mentors, recognised by the RSPH as adding a new dimension to school staffing, are carefully recruited and uniquely trained young people who inspire children to make better choices. The Health Mentors work alongside school staff to great effect and produce positive outcomes for both health (physical and mental) and education (improved attendance, behaviour and attainment).

    Evolve has greatest impact with disruptive children whose behaviour reflects their responses to ACEs and poverty – while having to fit into an education system that does not do enough to recognise their additional challenges in life. In the race for exam success they start with a handicap.

    Improving children’s physical, emotonal and cogitive health places them in a better place, more confident and resilient to deal with what life presents to them in the way of challenges and opportunities.

  3. Howard Wells

    Obesity is a life style choice that starts in the home. It is patents’ responsibility to educate children from the outset. Read, or listen to Dt Julie Wei’s talks on “The Milk and Cookie” disease. Her first question to parents is “What do your children eat and drink?” Children are entering school overweight and often unable to concentrate. How much is ADD to do with what children are eating and drinking.? Listen to her. It might just stop usblami g schools

  4. Daniel Forer

    Physical Activity/Sports in general and especially at schools shouldn’t be seen as a tool for tackling obesity and mental illness. They should be seen as a means to encourage individual and team participation amongst kids, understanding of competition, sportsmanship, variety of participation and the bonds formed through collective or individual wins and losses as well as with a role model like a coach. All of this builds a culture for sport/activity participation whose potential bi-product, if the hunger for it is truly instilled in children, could mean a reduction in obesity and mental health issues.

    Sport can also be inherently motivating as it’s a game/challenge. Random exercise is not and can often be seen as a chore especially if it’s just to tackle obesity. A wholistic approach is needed and to develop a positive culture around it.

  5. Andy Freeman

    A very interesting read Jonathan. Based on two very lengthy and heavily resourced programmes it seems very clear that it isn’t working. The answer seems very simple to the title of your article ‘NO’. I believe schools are definitely a cog in the wheel however in order to get the wheel working there needs to be more cogs. An holistic approach to tackling the Obesity crisis seems to be the best solution. I also like the Trial and Measure Model of trying lots of different programmes which are small but can be set up and delivered quickly. The programmes which show positive results should be explored, analysed and renewed on a bigger scale and then explored, analysed and renewed if they show further success.

  6. Thanks for article – I completely agree with it’s sentiment, and with a lot of the commentary above too. It’s a shame that these interventions didn’t show a difference for children. Unfortunately however, there are so many influences on individuals and families that it’s not wholly surprising. There are some interventions that seem to be benefiting children in schools, like the Daily Mile, but I agree that there has to be more done to tackle this problem from all sides in a whole system approach, rather than to rely on one route alone. That’s what the evidence shows us and how we at BeeZee Bodies approach making change with the families we work with.