School And Obesity
|Wendy Van Lippevelde|
|Zakstraat 9, 9300 Aalst East-Flanders, Belgium
Mobile phone: +32 (0) 486 155580 / Email: Wendy.VanLippevelde@ugent.be
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|Lea Maes is doctor in the medical sciences (public health).
She is full professor in the Department of Public Health.
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|Caroline Braet, Ph.D., is a professor in the Department of Developmental,
Personality, and Social Psychology at Ghent University in Belgium.
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Overweight and obesity have become a global health problem both in low and middle income countries and high income countries affecting all socioeconomic and age groups . Given the severe consequences on both physical and psychosocial health [2,3], prevention of overweight/obesity in children and adolescents is warranted. Several health behaviour models and frameworks (i.e., socio-ecological model, ANGELO framework, theory of planned behaviour, social-cognitive theory) emphasized the significant influence of the environment on children’s health behaviours [4-10]. Therefore, this chapter aims to contribute to the understanding of the role and importance of the school as institute related to obesity prevention starting with a focus on the negative outcomes of childhood overweight and obesity in a school context. Secondly, the influence of the school environment on childhood obesity will be presented followed by the assets of the school setting as a prevention setting. To conclude, an in depth overview of the role of parents in school-based obesity prevention will be given.
The negative outcomes of childhood obesity in a school context
Next to the physical health consequences, excess weight in children and adolescents causes serious psychosocial complications. Overweight children and adolescents often experience feelings of depression and anxiety [11-12], poor self-esteem [13-17], and social stigma [13,18-21] which subsequently affects the quality of life (QOL) [16,18,22]. The low QOL and psychosocial wellbeing in obese children and adolescents is comparable to that of children with a chronic disease such as cancer, diabetes, and gastrointestinal disorders [23,24]. Buttitta and colleagues  conducted a literature review on QOL assessment in overweight and obese children and adolescents and found lower QOL scores for school functioning (i.e., limitations in schoolwork; lower child’s perceptions of own cognitive capacity, learning and concentration; negative feelings about school; difficulties and anxiety at school; negative impact on school activities) and the social dimension (i.e., limitations in activities with friends; difficult interpersonal functioning in peer relations; negative impact on social activities; negative perception of the consideration in the social environment and the ability to develop friendships) in overweight and obese youth compared to normal weight children and adolescents. Earlier research has indicated that obesity is related to lower academic achievement and educational attainment [18,25,26]. However, no consistent evidence associates obesity to cognitive skills or scholastic abilities [27,28]. Some evidence suggests that reduced school achievements can be attributed to the social stigma of obesity [18,29]. Obese children and adolescents are more often the victims of bullying, discrimination, and bias than non-obese children [13,18]. Richardson and colleagues  explored stereotypical judgements of childhood obesity through an experiment in which 10- to 11-year-olds rated drawings of children with a range of disabilities: 1) no disability, 2) with crutches, 3) with wheelchair, 4) with no left hand, and 5) with obesity, and found that children liked the drawing of the obese child least because obese children are thought to be highly responsible for their condition. Latner & Stunkard  replicated this experiment hypothesizing that the high increase in overweight/obesity prevalence during the last 40 years caused a greater acceptance of obesity. However, the study showed that the stigmatization of childhood obesity was even stronger in 2001 than in 1961 . Other studies mirrored these findings and moreover indicate a steady rise in the stigma of obesity over the developmental stages [18,30-32]. These findings highlight the importance of anti-bullying policies at school.
Based on the perspectives of Cooley’s looking glass self  and Goffman’s social stigma , the stigmatization of obesity can create a climate of negative social feedback – either real or perceived- for obese youth which can cause emotional and behavioural problems leading to low self-efficacy and subsequently poor academic performance [18,29,35]. It should be noted that schools can be play an important role in the intensity of this stigma. Schools can develop -with their complex systems of norms and values including those related to physical appearance- a school culture in which obesity is more acceptable among youth . Several health behaviour models and frameworks such as Social Ecological models [5-7] and the Environmental Research framework for weight Gain (EnRG)  highlight the importance of examining environmental influences on health behaviours since a supportive environment is crucial for an individual’s health. Moreover, the contribution of the obesogenic environment in the expansion of the obesity epidemic is of major significance [37,38]. Therefore, the following section focuses on the influence of the school environment on childhood obesity.
The influence of the school environment on childhood obesity
Swinburn and colleagues  developed the ANGELO- (ANalysis Grid for Environments Linked to Obesity) – framework, a conceptual model for understanding the obesogenicity of environments, and included four distinct types of environmental influences (i.e. physical, economic, political, and sociocultural). Two systematic reviews used this framework to identify environmental factors related to energy balance-related behaviours in children and adolescents. Ferreira and colleagues  focused in their review on environmental factors related to physical activity (PA) and found that school-related PA policies (i.e. time allowed from free play; time spent outdoors; and number of field trips) were associated with PA. van der Horst and colleagues  explored the environmental factors linked to dietary behaviours but found no consistent associations. According to the abovementioned reviews [39,40], few studies are available that examine environmental influences on children’s and adolescents’ diet and PA in a school setting. Furthermore, a recent systematic review of reviews  confirmed these findings. De Vet and colleagues  did not find consistent associations between school factors and dietary behaviours. However, this review of reviews did show the importance of school facilities (i.e., instruction on sport/health benefits; school physical education programmes/school sport; equipment school play areas; and time allowed for free play/field trips) on PA in youth. However, Harrison & Jones  conducted a systematic review investigating associations between the physical school environment and diet, physical activity, and adiposity and found some evidence for the influence of the physical school food environment on children’s and adolescents’ food consumption . According to the authors, the availability and accessibility of unhealthy foods (i.e., sugar-sweetened drinks; low nutrient energy dense snacks; unhealthy la carte lunch programs) from school canteens and vending machines lead to a higher consumption of unhealthy foods, a lower intake of fruit, vegetables and milk products and greater odds of obesity. In addition, Harrison & Jones  found that intervention components altering food provision in school appear to be successful but modifications to the physical environment have a higher likelihood to be effective when combined with supportive social and educational changes. Furthermore, this review affirmed the importance of the physical school environment on PA . Based on the abovementioned reviews, it appears that the role of the school environment on dietary behaviours is not yet fully understood. Thus future research should provide more insight into the impact of school environmental factors on dietary behaviours. Nevertheless, it needs to be acknowledged that schools do not stand-alone as organization but are imbedded into broader macro-environmental settings including communities, health systems, governments and food industries . According to the Social Ecological models, an individual’s health behaviour is affected by, and effecting, various environmental levels of influence (including family, social networks, organizations, communities and societies) [4-7]. Obesity prevention efforts therefore need to target these different environmental types at multiple levels to significantly curb the obesity epidemic.
Obesity prevention in the school setting
Since children spend a large amount of their time at school and schools have many opportunities to conduct health promotion (i.e. health education lessons, the creation of a PA promoting playground; provision of healthy school meals); the school environment is recognized as a good setting to address children’s dietary, PA and sedentary behaviour (SB) [43,44]. The WHO started a Global School Health Initiative in 1995 which aimed to mobilise and strengthen health promotion and education activities at the local, national, regional and global levels and to improve the health of students, school personnel, families and other members of the community through schools. The main goal of this initiative was to increase the number of health promoting schools (HPS), i.e. schools that constantly strengthens its capacity as a healthy setting for living, learning and working . Several studies indicate that nutrition promotion programs using the HPS approach are promising in improving dietary behaviours .
Interventions targeting both dietary, PA and SB in children and adolescents have largely taken place in school settings. A range of outcomes have been targeted including healthy dietary patterns, increasing PA and decreasing SB and reducing weight status/weight gain. Some interventions used single components such as nutrition education or environmental changes, however, most interventions combined multiple components to influence energy balance-related behaviours (EBRBs) and weight status. Several systematic reviews found that well-designed and well-implemented school-based interventions have positive effects on children’s nutrition and PA behaviours. In addition, school-based interventions that combine both educational and environmental components and focus on both sides of the energy balance, are most likely to be effective. Nevertheless, to date, school-based interventions have had only limited success on behavioural outcomes and did not show any effects in reducing overweight prevalence, especially on the longer term [47-52].
Therefore, prevention strategies should be expanded to other settings in which children live, in order to reach and impact a majority of children at a substantial and meaningful level. As children spend another significant amount of their time at home with their parents, and moreover, parents and their parenting has a significant influence on children’s energy balance-related behaviours and obesity development [53-56], it is likely that engaging parents and focusing on these parenting practices in obesity prevention interventions will enhance the long-term impact and sustainability of obesity prevention efforts. Consequently, parents should be actively involved in obesity prevention efforts too. In the following section, an overview of the current knowledge is provided concerning parental involvement in school-based obesity prevention including evidence about effectiveness of parental involvement, used strategies to involve parents and target parenting practices, and characteristics of participating parents in school-based obesity prevention.
The role of parents in school-based obesity prevention
A large range of systematic reviews investigated the effectiveness of parental involvement in school-based obesity prevention on behavioural and/or anthropometrical outcomes. Nevertheless, no conclusive evidence was found for the added value of parental participation in school-based obesity prevention. On the one hand, earlier research found some evidence for the effectiveness of engaging parents in school-based healthy diet and PA promoting and obesity preventing programs in children and/or adolescents [57-62]. However, none of the reviews exclusively included studies wherein the parent component in the school-based intervention was separately evaluated. Thus the contribution of parental involvement to intervention effectiveness could not be determined. These reviews only stated that school-based interventions with a family component appear to be more effective than those programs that did not. In contrast, some systematic reviews reported inconsistent findings. Both Kahn et al.  and Thomas et al.  reported no added value of parental participation in, respectively, school-based PA promotion and general obesity prevention interventions. Doak and colleagues  compared intervention components of effective and non-effective childhood overweight prevention programs and found that the effective studies were less likely to include parents in their interventions. Additionally, two meta-analyses [65,66] tested the hypothesis that obesity prevention programs with parental involvement would have larger effects than those without. Stice and colleagues  found that parental participation did not significantly increase interventions’ effectiveness whereas Katz et al. concluded that parental involvement may be valuable. To date, only few intervention studies are developed that are solely parent-based or include an extra comparison group for testing the family component effectiveness. Most efforts to involve parents are components of more comprehensive interventions . Van Lippevelde and colleagues  conducted a systematic review solely including school- and family-based intervention studies with such a design that the added value of the parental intervention component could be determined. However, since only five studies could be extracted and because the identified studies had inconsistent findings, this review could not provide conclusive evidence about the specific contribution of parental involvement to the effectiveness of school-based obesity prevention. In addition, the included studies did not provide detailed information about intervention content, dose and reach of the parental component thus no statements could be made about the most effective parental intervention strategies. Notwithstanding, parental interventions that included a range of strategies and focused on several parenting practices (i.e., monitoring, having rules, role-modeling) appeared to have a higher likelihood to be successful. Similar results were found by Golley and colleagues  who found that family-based interventions were more likely to be effective when more behaviour change techniques were used to target parents and their practices.
Hingle and colleagues  and O’Connor and colleagues  reviewed the literature regarding what type of parental involvement was most effective in changing dietary and PA outcomes in children, respectively. Stronger evidence was found for direct methods/strategies to reach and involve parents such as parental attendance at education sessions, parent training sessions, family behaviour counseling face-to-face or through telephone contact. These parental intervention strategies were more likely to result in positive changes in dietary and PA behavioural outcomes compared with those studies that used more indirect methods (e.g. educational information materials). Furthermore, indirect parental strategies related to nutrition in which parents were engaged through their children (i.e. homework assignments) were also more likely to have positive findings. However, this was not the case for PA promoting family intervention strategies as O’Connor and colleagues  found no positive results for family PA or exercise programs together with their child. However, both reviews found that indirect methods were most commonly used to engage parents [67,70]. This was supported by Roseman and colleagues  who provided an overview of the most common methods and strategies to reach the home environment. The most used strategy to educate and remind parents about the importance of healthy dietary patterns was sending home newsletters. Other methods such as sending brochures and videotapes emphasizing modelling of desired behaviours were alternatives. Common strategies to actively involve parents were the organization of parent-teacher meetings, family counseling about diet, parent forum/website, parent-child homework, provision of cookbook/recipes of food to prepare at home . Nevertheless, only limited conclusions can be drawn from the reviews of Hingle and colleagues  and O’Connor and colleagues  regarding the best method to involve parents given the variability in study design, and used outcomes and measurements. Similarly, Golley and colleagues  investigated whether intervention content and behaviour change techniques used in family-based interventions are associated with intervention effectiveness. They found that family-based interventions had a higher likelihood of being effective if they included most of the following characteristics: parents were responsible for intervention participation and implementation (rather than the child), a higher degree of meaningful parental involvement targeting energy intake/density or food choices, use of more behaviour change techniques and use of particular techniques (environmental restructuring, specific goal setting, monitoring, and barrier identification). Intervention effectiveness also increased if the use of behaviour change techniques spanned a behaviour change process .
Despite of all the current knowledge about the most effective family-based intervention strategies targeting EBRBs, the previous reviews reported that most intervention studies did not include data about how many and which parents participated. Moreover, earlier studies emphasized the difficulty to involve parents in school-based interventions since parents are often not eager to participate in school-based interventions and, moreover, they have little spare time next to their work and household [72,73]. In order to explore possible strategies to involve and influence parents via school-based obesity prevention, Van Lippevelde and colleagues  conducted focus group research in four European countries with parents of 10- to 12-year-olds to get more insight into parents’ perspectives about parental involvement in school-based obesity prevention. Parents proposed interactive and practical activities together with their child as the best way to involve them such as cooking, food tasting, and nutrition workshops, walking or cycling tours, sport initiations together with their child. Activities should be cheap, on a convenient moment, focused on their children and not on themselves, not tutoring nor theoretical, and at school or home.
Across all aforementioned studies, authors highlighted that it is difficult to determine whether or not parental involvement positively impacts on outcomes and to identify which strategies to engage parents were most effective. This is due to the heterogeneity in study design, study quality, outcome variables and measurements used to assess outcomes, and the poor description of intervention fidelity, dose, and exposure. Consequently, future research should try to solve this lack of clarity about the importance and effectiveness of parental involvement in obesity prevention by designing studies in such a way that it will be possible to extract the added value of the parental component. However, alternative strategies and channels to effectively target the home environment and parenting practices also need to be explored, i.e., community-based interventions.
- World Health Organisation Technical Report Ser. Obesity: preventing and managing the global epidemic. Report of a WHO consultation 2000;894:i-xii,1-253.
- Han JC, Lawlor DA, Kimm SYS. Childhood obesity. Lancet 2010;375:1737-1748.
- Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. The International Association for the Study of Obesity. Obes Rev 2004;5(1):4-85.
- Bartholomew LK, Parcel GS, Kok G, Gottlieb NH. Planning health promotion programs: An Intervention Mapping Approach. San Francisco: Jossey-Bass, 2006:8-14.
- McLeroy KR, Bibeay D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988;15:351-77.
- Sallis JF, Owen N. Ecological models. In: Glanz K, Lewis FM, Rimer BK (eds). Health behavior and health education: Theory, research, and practice, 2nd edition. San Francisco: Jossey-Bass, 1996:403-424.
- Stokols D. Establishing and maintaining healthy environment: toward a social ecology of health promotion. Am Psychol 1992;47:6-22.
- Bandura A. Self-efficacy: The exercise of control. NewYork: Freeman 1997.
- Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes 1991;50:179–211.
- Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development an application of a framework for identifying and prioritizing environmental intervention for obesity. Prev Med 1999; 29:563-570.
- Vila G, Zipper E, Dabbas M, Bertrand C, Robert JJ, Ricour C, Mouren-Siméoni MC. Mental disorders in obese children. Psychosom Med 2004;66:387−394.
- Erermis S, Cetin N, Tamar M, Bukusoglu N, Akdeniz F, Goksen D. Is obesity a risk factor for psychopathology among adolescents? Pediatrics International 2004;46(3):296–301.
- Warschburger P. The unhappy obese child. International Journal of Obesity 2005;29:S127-129.
- Strauss Richard. Childhood obesity and self-esteem. Pediatrics 2000;105:e15.
- Miller CT, Downey KT. A meta-analysis of heavyweight and self-esteem. Pers Soc Psychol Rev 1999;3:68–84.
- Griffiths LJ, Parsons TJ, Hill AJ. Self-esteem and quality of life in obese children and adolescents: A systematic review. International Journal of Pediatric Obesity 2010;5(4),282–304.
- Nowicka P, Höglund P, Birgerstam P, Lissau I, Pietrobelli A, Flodmark C-E. Self-esteem in a clinical sample of morbidly obese children and adolescents. Acta Paediatrica 2009;98(1):153–158.
- Puhl RM, King KM. Weight discrimination and bullying. Best Pract Res Clin Endocrinol Metab 2013;27(2):117-27.
- Gray WN, Kahhan NA, Janicke DM. Peer victimization and pediatric obesity: A review of the literature. Psychology in the Schools 2004;46(8):720–728.
- Richardson SA, Goodman N, Hastorf AH, Dornbusch SM. Cultural uniformity in reaction to physical disabilities. Am Sociol Rev 1961;26:241–7.
- Latner JD, Stunkard AJ. Getting worse: the stigmatization of obese children. Obes Res 2003;11(3):452-6.
- Buttitta M, Iliescu C, Rousseau A, Guerrien A. Quality of life in overweight and obese children and adolescents: a literature review. Quality of life research 2013.
- Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. Journal of the American Medical Association 2003;289(14):1813–1819.
- Varni JW, Limbers CA, Burwinkle TM. Impaired health-related quality of life in children and adolescents with chronic conditions: A comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL™ 4.0 Generic Core Scales. Health and Quality of Life Outcomes 2007; 5:43.
- Ball, Kylie, David Crawford, and Justin Kenardy. Longitudinal Relationships Among Overweight, Life Satisfaction, and Aspirations in Young Women. Obesity Research 2004; 12:1019–30.
- Crosnoe Robert, Muller C. Body Mass Index, Academic Achievement, and School Context: Examining the Educational Experiences of Adolescent at Risk of Obesity. Journal of Health and Social Behavior 2004;45:393-407.
- Carr, Deborah, and Michael A. Friedman. Is Obesity Stigmatizing? Body Weight, Perceived Discrimination, and Psychological Well-Being in the United States. Journal of Health and Social Behavior 2005;46:244-59.
- Cawley J. Body Weight and the Dating Behaviors of Young Adolescents. In Social Awakening: Adolescent Behavior as Adulthood Approaches, edited by Robert T. Michael. New York: Russell Sage Foundation,2001:174-98.
- Crosnoe Robert. Gender, obesity, and education. Sociology of Education 2007;80:241-260.
- Flannery-Schroeder EC, Chrisler JC. Body esteem, eating attitudes, and gender-role orientation in three age groups of children. Curr Psychol: Dev, Learn, Pers, Soc 1996;15:235-48.
- Cramer P, Steinwert, T. Thin is good, fat is bad: how early does it begin? J Appl Dev Psychol 1998;19:429–51.
- Sigelman CK, Miller TE, Whitworth LA. The early development of stigmatizing reactions to physical disabilities. J Appl Dev Psychol 1986;7:17–32.
- Cooley CH. Human Nature and the Social Order. New Brunswick, NJ: Transaction  1983.
- Goffman Erving. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall, 1963.
- Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WM. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993;329:1008–1012.
- Kremers SPJ, de Bruyn G-J, Visscher TLS, van Mechelen W, de Vries NK, Brug J. Environmental influences on energy balance-related behaviors: A dual-process view. Int J Behav Nutr Phys Act 2006;3:9.
- Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment: Where do we go from here? Science 2003;299:853-855.
- World Health Organization Technical Report Ser. Diet, nutrition and the prevention of chronic diseases 2003; 916:i-viii,1-149.
- Ferreira I, van der Horst K, Wendel-Vos W, Kremers S, van Lenthe FJ, Brug J. Environmental determinants of physical activity in youth: a review and update. Obes Rev 2006;8:129-154.
- Van der Horst K, Oenema A, Ferreira I et al. A systematic review of environmental correlates of obesity-related dietary behaviors in youth. Health Educ Res 2007;22:203–26.
- de Vet E, De Ridder DTD, de Wit JBF. Environmental correlates of physical activity and dietary behaviours among young people: a systematic review of reviews. Obesity reviews 2010;12:e130-142.
- Harrison F, Jones A. A framework for understanding school-based physical environmental influences on childhood obesity. Health & Place 2012;18:639-648.
- Story M, Kaphingst KM, French S. The role of schools in obesity prevention. Future child 2006;16(1):109-142.
- Wechsler H, Devereaux RS, Davis M, Collins J. Using the School Environment to Promote Physical Activity and Healthy Eating. Preventive Medicine 2000;31:S121-S137.
- World Health Organisation. Global school health initiative. (accessed February 27, 2014, http://www.who.int/school_youth_health/gshi/en/).
- Wang D, Stewart D. The implementation and effectiveness effectiveness of school-based nutrition promotion programmes using a health-promoting schoolsls approach: a systematic review. Public Health Nutr 2013 Jun;16(6):1082-100.
- Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev 2009;10:110-141.
- De Bourdeaudhuij I, Van Cauwenberghe E, Spittaels H, Oppert J-M, Rostami C, Brug J, Van Lenthe F, Lobstein T, Maes L. School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obes Rev. 2010;12:205-216.
- Sharma M. School-based interventions for childhood and adolescent obesity. Obes Rev. 2006;7:261-269.
- Sharma M. International school-based interventions for preventing obesity in children. Obes Rev 2006;8(2):155-167.
- Thomas H. Obesity prevention programs for children and youth: why are their results so modest? Health Educ Res 2006;21(6):783-795.
- Van Cauwenberghe E, Maes L, Spittaels H, van Lenthe FJ, Brug J, Oppert JM, De Bourdeaudhuij I. Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and ‘grey’ literature. Br J Nutr. 2010;103(6):781–797.
- Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev 2004; 62:39–50
- Stang J, Loth KA. Parenting style and child feeding practices: potential mitigating factors in the etiology of childhood obesity. J Am Diet Assoc 2011;111(9):1301-1305.
- Rosenkranz RR, Dzewaltowski DA. Model of the home food environment pertaining to childhood obesity. Nutr Rev 2008;66(3):123–140.
- Ventura AK, Birch LL. Does parenting affect children’s eating and weight status? Int J of Behav Nutr Phys Act 2008;5:15.
- Hoelscher DM, Evans A, Parcel GS, Kelder SH. Designing effective nutrition interventions for adolescents. J Am Diet Assoc 2002;102(3):S52-S63.
- Knai C, Pomerleau J, Lock K, McKee M. Getting children to eat more fruit and vegetables: A systematic review. Prev Med 2006;42:85-95.
- Peters LW, Kok G, Ten Dam GT, Buijs GJ, Paulussen TGWM. Effective elements of school health promotion across behavioral domains: a systematic review of reviews. BMC Public Health 2009;12(9):182–196.
- Thomas H, Ciliska D, Micucci S, Wilson-Abra J, Dobbins M. Effectiveness of physical activity enhancement and obesity prevention in children and youth. Hamilton/Toronto, Ontario, Canada: Effective Public Health Practice Project/Public Health Research, Education and Development (PHRED) Program, Public Health Branch, Ontario Ministry of Health and Long-Term Care, 2004.
- Timperio A, Salmon J, Ball K. Evidence-based strategies to promote physical activity among children, adolescents and young adults: review and update. J Sci Med Sport 2004;7:20-9.
- van Sluijs EMF, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. Br J Sports Med 2008;42(8):653-657.
- Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW, Corso P. The effectiveness of interventions to increase physical activity – A systematic review. Am J Prev Med 2002;22(4):73-108.
- Doak CM, Visscher TLS, Renders CM, Seidell JC. The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obes Rev 2006;7(1):111-136.
- Katz DL, O’Connell M, Njike VY, Yeh MC, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes (Lond). 2008;32(12):1780-1789.
- Stice E, Shaw H, Marti CN. A meta-analytic review of obesity prevention programs for children and adolescents: The skinny on interventions that work. Psychol Bull 2006;132(5):667-691.
- Hingle MD, O’Connor TM, Dave JM, Baranowski T. Parental involvement in interventions to improve child dietary intake: a systematic review. Prev Med 2010;51(2):103-111.
- Van Lippevelde W, Verloigne M, De Bourdeaudhuij I, Brug J, Bjelland M, Lien N, Maes L. Does parental involvement make a difference in school-based nutrition and physical activity interventions? A systematic review of randomized controlled trials. International Journal of Public Health 2012; 57(4):673-8.
- Golley RK, Hendrie GA, Slater A, Corsini N. Interventions that involve parents to improve children’s weight-related nutrition intake and activity patterns—what nutrition and activity targets and behaviour change techniques are associated with intervention effectiveness. Obes Rev 2010; 2(2):114–130.
- O’Connor TM, Jago R, Baranowski T. Engaging parents to increase youth physical activity. A systematic review. Am J Prev Med 2009;37(2):141-149.
- Roseman MG, Riddell MC, Haynes JN. A content analysis of kindergarten-12th grade schoolbased nutrition interventions: taking advantage of past learning. J Nutr Educ Behav 2011;43(1):1-18 .
- Gentile DA, Welk G, Eisenmann JC, Reimer RA, Walsh DA, Russell DW, Callahan R, Walsh M, Strickland S, Fritz K. Evaluation of a multiple ecological level child obesity prevention program: Switch what you DO, View, and Chew. BMC Medicine 2009;7:49.
- Perry CL, Crockett SJ, Pirie P. Influencing parental health behaviour: Implications of community assessments. Health Educ 1987;18(5):68-77.
- Van Lippevelde W, Verloigne M, De Bourdeaudhuij I, Bjelland M, Lien N, Fernández-Alvira JM, Moreno LA, Kovacs E, Brug J, Maes L. What do parents think about parental participation in school-based interventions on energy balance-related behaviours? A qualitative study in 4 countries. BMC Public Health 2011; 23(11): 881.