Epidemic of childhood obesity among Chinese children and effectiveness of school-based interventions

Abstract

Obesity prevalence among children is rising virtually in all countries with rapid acceleration in countries with brisk economic development such as China. Changing dietary habits and increasing sedentary lifestyles due to urbanization cause the negative energy balance accounting for the rapid rise of childhood obesity. School is an ideal setting for the prevention of obesity as children spend half of their waking hours there. However, evidence is conflicted on the effectiveness of school-based interventions. In this paper, we give a review of literature on why conventional school-based interventions for healthy eating and promoting physical activity would not reach their objectives. The Health Promoting School (HPS) framework would be a feasible strategy as it not only focuses on building up personal health skills but also imposes school policies on healthy eating and physical activities, modification of school environment (physical and social), re-orientation of health services toward health promotion and health protection, and partnership with parents and community. A case study in Hong Kong is used to illustrate how one would make use of an HPS model to modify the determinant factors for obesity in a school setting and sustain the momentum. Prevention of childhood obesity is complex as one cannot stop food intake and force physical activity. There is a need for societal changes to modify the environment and culture, and the HPS framework would provide a good starting point at the school level, as schools are a microcosm of a society.