BACKGROUND: An important challenge of school-based childhood obesity (OB) intervention programs is understanding the maintenance of the effects after cessation of the intervention to overcome the limitations of follow-up studies. The aim of this study is to verify the sustainability of the benefits achieved at a 4-year follow-up of the post-Educació en Alimentació (EDAl) program intervention cessation by assessing the OB-related outcomes and lifestyles of 13- to 15-year-old adolescents. METHODS: This paper describes a 4-year follow-up study after the cessation of a school-based randomized controlled intervention in adolescents (n = 349, intervention; n = 154, control) with baseline and 4-year follow-up data from high schools in Reus (intervention group), Salou, Cambrils and Vila-seca (control group). The outcomes are body mass index (BMI), BMI z-score, and OB prevalence according to the World Health Organization and International Obesity Task Force criteria and lifestyle data (obtained from questionnaires). RESULTS: Compared with the control girls, the intervention girls showed reduced BMI z-scores (-0.33 units, p < 0.01) from baseline (2007) to the 4-year follow-up post-intervention (2014). Compared with the control boys, the intervention boys showed reduced OB prevalence (-7.7%; p = 0.02). Compared with the control boys, more boys in the intervention group (19% increase; p = 0.059) showed ≥4 h/week after-school physical activity (PA). A decrease in the consumption of dairy products, fruits and fish was observed in both groups. CONCLUSIONS: At the 4-year post-intervention follow-up of the EdAl program, compared with the control groups, girls had lower BMI z-scores and boys had lower OB prevalence from the intervention. The encouragement in after-school PA was long-lasting and maintained after the cessation of the intervention, whereas healthy food habits must be further reinforced in adolescents. TRIAL REGISTRATION: ISRCTN29247645
We express our appreciation to the university medical and health science students of the Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili (Reus, Spain), as well as the staff, parents and children of the primary and high schools of Reus, Cambrils, Salou and Vila-seca for their enthusiastic support in this study.
This work was partially supported by grants from the Instituto de Salud Carlos III-ISCIII (Spanish Government) cofunded by FEDER funds / European Regional Development Fund (ERDF) - a way to build Europe (References: RD12/0036/0056, PI11/02090 and PI16/01254) and from the Agència de Gestió d’Ajuts Universitaris i de Recerca (2014SGR756) and RecerCaixa 2015 (2015ACUP00129).
This research project has been supported by Fundació Privada Reddis, Ajuntament de Reus, Vila-seca, Salou i Cambrils (Spain); Nutrition and Health Technology Centre-TECNIO CT09–1-0019, Reus (Spain); Diputació de Tarragona (Spain). These funders did not play a role in the Spanish study design, data collection, study management, data analysis, interpretation of the data, writing of the report, or decision to submit the report for publication.
Availability of data and materials
The technical appendix, statistical code and dataset are available from the corresponding author. Email: firstname.lastname@example.org.
- school-based interventions