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Review
. 2021 Dec 20;18(24):13395.
doi: 10.3390/ijerph182413395.

Preventing Childhood Obesity in Primary Schools: A Realist Review from UK Perspective

Sharea Ijaz  1   2 , James Nobles  1   2 , Laura Johnson  3 , Theresa Moore  1   2   4 , Jelena Savović  1   2 , Russell Jago  1   3
Affiliations
Review

Preventing Childhood Obesity in Primary Schools: A Realist Review from UK Perspective

Sharea Ijaz et al. Int J Environ Res Public Health. .

Abstract

Childhood obesity is a global public health concern. While evidence from a recent comprehensive Cochrane review indicates school-based interventions can prevent obesity, we still do not know how or for whom these work best. We aimed to identify the contextual and mechanistic factors associated with obesity prevention interventions implementable in primary schools. A realist synthesis following the Realist And Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES) guidance was with eligible studies from the 2019 Cochrane review on interventions in primary schools. The initial programme theory was developed through expert consensus and stakeholder input and refined with data from included studies to produce a final programme theory including all of the context-mechanism-outcome configurations. We included 24 studies (71 documents) in our synthesis. We found that baseline standardised body mass index (BMIz) affects intervention mechanisms variably as a contextual factor. Girls, older children and those with higher parental education consistently benefitted more from school-based interventions. The key mechanisms associated with beneficial effect were sufficient intervention dose, environmental modification and the intervention components working together as a whole. Education alone was not associated with favourable outcomes. Future interventions should go beyond education and incorporate a sufficient dose to trigger change in BMIz. Contextual factors deserve consideration when commissioning interventions to avoid widening health inequalities.

Keywords: childhood obesity; primary school; realist synthesis.

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Conflict of interest statement

Russell Jago reports grants from the National Institute of Health Research during the conduct of the study. Other authors have no competing interests to report.

Figures

Figure 2
Figure 2
Final programme theory showing CMOs from all included studies. Dotted black lines indicate which contexts affected which outcomes. Continuous black lines from mechanism to outcomes indicate a favourable change (e.g., improved physical activity (PA) levels) while continuous red lines indicate lack of a favourable change (e.g., no difference in PA levels or an unfavourable change (e.g., lower PA levels). [] bracketed letters underneath the lines indicate respective studies for that CMO line. Green brackets refer to studies that found a favourable BMIz change (effective studies) and red refer to those that did not (ineffective studies): A = deRuyter, 2012 [24]; B = Khan, 2014 [32]; C = Li, 2010 [35]; D = Marcus, 2009 [36]; E = Spiegel, 2006 [44]; F = Fairclough, 2013 [25]; G = Cao, 2015 [22]; H = Sahota, 2001 [41]; I = Gutin, 2008 [28]; J = Lazaar, 2007 [34]; K = Damsgaard, 2014 [23]; L = Rush, 2012 [40]; M = Grydeland, 2014 [27]; N = James, 2004 [30]; O = Meng, 2013 [37]; P = Rosario, 2012 [39]; Q = Foster, 2008 [26]; R = Muckelbauer, 2010 [38]; S = Santos, 2014 [42]; T = Siegrist, 2013 [43]; U = Williamson, 2012 [45]; V = Herscovici, 2013 [29]; W = Johnston, 2013 [31]; X = Kipping, 2014 [33].
Figure 1
Figure 1
The initial programme theory.
See this image and copyright information in PMC

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