Julia Gago, Oscar Rosas. FETP –Perú.

Effect of educational intervention to prevent and

control the increase overweight and obesity in

schoolchildren from public elementary schools in

marginal-urban district of Villa El Salvador in Lima, Peru from 2010 to 2011.

Julia Gago, Oscar Rosas.FETP –Perú.

Outline.

• Definition.– Obesity – Situation

• Objectives.• Methods.• Results.• Conclusions.• Recommendations.

Obesity.

• It´s an abnormal or excessive fat accumulation in adipose tissue, to the extent that health may be impaired.

• The WHO recommends the use of Body Mass Index (BMI); it provides the most useful, albeit crude, population-level measure of obesity.

• BMI is well corralated to:– relative adiposity, – fat mass, and – cardiovascular risk factors in chidren and adults.

Source: WHO | Obesity: preventing and managing the global epidemic [Internet]. WHO. [citado 2012 mar 8]. Available: http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/index.html

Obesity.

Causes1. Low physical activity. 2. Consumption of foods

rich in fat and sugars.3. Consumption of high-

density, low-cost foods.4. Expression of the “thrifty

gene” and chronic undernutrition.

Consequences1. Psychosocial and

economic consequences.

2. Increase of risk factors for chronical diseases.

3. Increase on morbidity. 4. Increase on mortality.

Source: Frisancho A.R. Globalization of obesity: The price of industrialization. Humankind evolving: an exploration of the origins of human diversity. Kendall/Hunt; 2006. p. 436.

Prevalence of obesity worldwide - 2010.

Prevalence of adults with obesity

Source: IATSO. International Obesity Task Force. Avilable in: http://www.iaso.org/iotf/obesity/?map=adults

Peru (In adults women 2008: 14.6%)

http://www.iaso.org/iotf/obesity/?map=adults

Normal, 63.4Overweight, 20.6

Obese, 15.5

Underweight, 0.5

Prevalence of overweight and obesity in Schoolchildren in Lima Capital City - 2008.

Source: IIN/ ILSI (2008) Perfil nutricional en escolares de Lima y Callao. Available in: http://www.iin.sld.pe/pdf/2008/Perfil_nutricional_en_escolares_de_limayallao.pdf?PHPSESSID=67705da3600ffbb650852b1bcc22b00b

http://www.iin.sld.pe/pdf/2008/Perfil_nutricional_en_escolares_de_limayallao.pdf?PHPSESSID=67705da3600ffbb650852b1bcc22b00b

Objective.

• Determine the effectiveness of a nutrition education intervention on the prevention and control of overweight and obesity.

Methods

• Non-randomized, controlled community intervention study.

• 529 school children ( 5-12 yo) from four elementary schools in Villa El Salvador Lima –Peru.

• Intervention: Educative intervention in nutrition and health.• Outcome:

– Body Mass Index (BMI Z-score)– Proportion of overweight and obesity after intervention.

• Analysis: We analyzed the mean differences of this index, using T-test.

Sub Tropical. Relative Humidity 100%. 35.40 Km2.175 m.o.s.l.

De 18 a 19º C. (Mean)Variation of 6 ºC.

Villa El Salvador Map.

Fuente: Google maps.District Population 2010: 409 431 inhabitants.

District school children: 41 218

Health worker team

Teachers

SchoolchildrenParents

Teachers

Strengthening skills in food and nutrition.

Educational session for

schoolchildren

Parents sensitization.

Signed Evidence.

Collect and consolidate the

evidence

Educative intervention process.

Seven intervention messages.

Educative intervention messages.COME FRECUENTEMENTE ALIMENTOS

DE ORIGEN ANIMAL RICOS EN HIERRO.

3

Como sangrecita, bazo, hígado, pescado y otras carnes o vísceras rojas.

Mensaje

Incluir en la alimentación diaria algún tipo de carne o víscera de color rojo como: sangrecita, bazo, hígado, pescado, bofe, etc. Estos alimentos son fuente de hierro que ayudan a prevenir la anemia ynuestro organismo lo absorbe mejor para crecer sanos, fuertes e inteligentes.En casos de sobrepeso se aconseja comer más pescado de carne oscura.

Fuente: Equipo de Nutrición de DRS.VES.LPP 2010.

COME DIARIAMENTE CINCO COMIDAS ESPESAS Y CONSISTENTES HECHAS EN

CASA

2

32

Desayuno

Lonchera

Almuerzo Cena

Refrigerio

Comidasprincipales

Refrigerios

Mensaje

Los escolares deben tener 3 comidas principales y dos refrigerios.Comer primero una comida espesa como mazamorra, sandwich o el segundo quealimenta más que la sopa, luego la fruta y el refresco natural.Comer sólo una ración, masticando bien y disfrutando la comida en familia.Evitar realizar otras actividades mientras comes como ver televisión, leer, hacertareas, etc.

Fuente: Equipo de Salud y Nutrición de DRS.VES.LPP 2010.

1. Eat five dense meals home made daily.

2. Eat frequently animal rich iron foods.

Educative intervention messages.COME DIARIAMENTE CINCO FRUTAS Y

VERDURAS DE DIFERENTES COLORES.

4

Mensaje

Todos debemos comer diariamente como mínimo 5 raciones de frutas yverduras en el día, porque nos aportan vitaminas, minerales y fibra, que nosayudan a tener una buena digestión y no sufrir de estreñimiento. Las frutas y verduras contienen nutrientes que aumentan nuestras defensaspara no enfermarnos.

EVITA COMER FRITURAS, ALIMENTOS DULCES Y SALADOS EN EXCESO PUES TE

LLEVARAN AL SOBREPESO

5

Mensaje

Comer o tomar alimentos muy dulces o muy salados nos van a hacer subir de peso excesivamente y hacer daño.Evitar consumir: gaseosas, jugos de frutas envasados, golosinas como chocolates, galletas y alimentos envasados en general.Evitar comer “comida chatarra” dentro y fuera del colegio: (hamburguesas,salchipapas, alitas broaster, etc.)

Debemos llevar en la lonchera alimentos preparados en casa.


3. Eat five fruits and vegetables of different colors daily.

4. Avoid eating snacks, sweet and salty foods in excess, then will push you to

overweight.

Educative intervention messages.

EL EJERCICIO DIARIO TE MANTENDRA BIEN

6

¡ESCUELAS ACTIVAS, ESCUELAS SALUDABLES!Mensaje

Hacer 30 minutos de actividad física diariamente aparte de todas las actividadesque realizas así ayudas a tu cuerpo a funcionar bien: “Te hace sentir bien y vertemejor”. Estimular en los niños y niñas la práctica del ejercicio , el deporte y la recreaciónactiva en la escuela y el hogar para tener una comunidad saludable.


MANTÉN LA HIGIENE PERSONAL, DE MANOS, DIENTES Y UTENSILIOS

7

Mensaje

Realizar una higiene adecuada siempre te mantendrá saludable……por eso todos los días debes asearte.Lavarse las manos con agua y jabón antes y después de comer tus alimentos,después de ir al baño y después de jugar con las mascotas, así evitarás muchasenfermedades.Cepillarse los dientes al despertar, antes de ir a dormir y después de cadacomida.Recuerda lavar bien los platos y los cubiertos y taparlos bien para que no secontaminen.


5. Daily exercise will keep you well.

6. Keep personal hygiene, of hands, teeth and dishes.

Educative intervention messages.

RECUERDA QUE UNA ALIMENTACION BALANCEADA

ES:Combinar en cada comida

1 Alimento energético.

1 Alimento regulador.

1 Alimento constructor.

ALIMENTOS REGULADORES

ALIMENTOS CONSTRUCTORES

ALIMENTOS ENERGÉTIOS


7. Balance your food.

Intervention design

Commitment InitialEvaluation

Educative Intervention

Final Evaluation

Timeline of the intervention.

Jan 2009Mar 2010

Mar 2010May 2010

May 2010Jun 2010

Jun 2010Nov 2010

May 2011Jun 2011

Enrollment.

223

Lost: 22 (9.9%)

Overweight –Obese: 106

(52.8%)

n=201

Normal: 95 (47.2%)

367

Lost: 39 (10.6%)

n=328

Underweight: 4 (1.2%)

Overweight –Obese: 147

(44.8%)

Normal: 177 (54%)

Global Global

Prevention Recovery

Prevention Recovery

Intervention group(2 Schools)

Control group(2 Schools)

Normal, 54.0Overweight,

24.1

Obese, 20.7

Underweight, 1.2

Intervention Group

Initial Final

Global effectiveness of intervention.

Results.

Control Group

Initial Final

Normal, 47.2

Overweight, 28.4

Obese, 24.4

Normal, 60.2Overweight, 18.9

Obese, 20.9

Normal, 50.3

Overweight, 22.9

Obese, 26.8

p < 0.05

p < 0.05

Intervention Group

Control Group

p < 0.05

p < 0.05

Initial Final

Initial Final

Effectiveness on prevention of obesity and overweight.

Results.

Normal, 100

Normal, 100Normal, 78.0

Overweight and Obese,

22.0

Normal, 90.5

Overweight and Obese,

9.5

Intervention Group

Control Group

p < 0.05

p < 0.05

Initial Final

Initial Final

Effectiveness on recovery of obesity and overweight.

Results.

Overweight and obese,

100


100

Normal, 33


67

Normal, 15.6


84.4

Results.Variable (Z-scores) Initial Final P value*.

BMI (mean) 1.33 1.05 0.000

Height (mean) -0.80 -0.67 0.000

BMI (mean) 1.04 1.23 0.001

Height (mean) -0.68 -0.53 0.000

BMI (mean) 0.276 0.114 0.013Height (mean) -0.946 -0.850 0.034



BMI (mean) 2.35 2.38 0.727Height (mean) -0.50 -0.29 0.000Difference of BMI betw een groups in all subgroups (global, prev ention and recov ery ) w as significativ e p<0.05.

* T-student test.

Control Group (C.G.)

Intervention Group (I.G.)


Global

Prevention on overweight and obesityIntervention Group (I.G.)


Recovery from overweight and obesityIntervention Group (I.G.)

Conclusions.

• The Nutritional intervention is effective in preventing and controlling overweight and obesity in the study period.

• Growth was similar in each group.• A multi institutional partnership and commitment

for educational intervention could be a community approach alternative to prevent and control overweight and obesity in schoolchildren from urban-marginal districts of major cities.

Limitations.

• It was not possible to randomize because the kind of the study (Community intervention).

• We could not intervene in school kiosk.• The study only reflects a periurban area of Lima

city.• We could not know the educative level of

parents.• We do not know the sustainability of the

intervention yet.

Recommendations.

• The "Health promotion team" must perform interventions with a managerial epidemiology approach.

• Obtain the commitment from all involved.• A shared goal must be the foundation of this

intervention between community; health and education sectors.

Life time

Early learning

Healthy lifestyle.

Learning for life.

Get Experience

dLear

ning

Thanks for your attention.

Julia Gago, Oscar Rosas. FETP –Perú.

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