2.2. Description of Intervention
obesity, weight gain, school-aged, overweight or obesity, weight loss
OBESITY, ADVERSE EFFECTS
Based on the social ecological model, the multifaceted intervention for the prevention of obesity among school-aged children included five components (three targeting children and two targeting their school and family environment) and lasted for 9 months from 11 September 2018 to 30 June 2019. A smartphone app was used to strengthen parental involvement and cooperation. See the published research protocol for a detailed description of the intervention methods [In terms of improving children’s body image, the intervention measures mainly included health-education activities, regularly monitoring children’s weight and giving personal feedback. Children’s health-education activities were carried out 10 times in total (once every 2~3 weeks, each lasting for 40 min), in which children were taught to establish the correct measurement and an evaluation of their own body shape. To improve their motivation on control of their weight gain, children and their parents were also educated about the adverse effects of obesity on health and life. Weight monitoring and feedback were carried out by school doctors or teachers. They measured the height and the weight of each child once a month, and gave personal feedback on actual weight status to children and their parents through a smartphone app regularly. Children were also told how to evaluate their nutritional status based on their BMI, and encouraged to measure their weight by themselves once a week. The control schools just took regular school health and physical education activities. In order to avoid unnecessary weight loss and help children form an appropriate attitude towards their body image, the intervention took targeted measures for children with different nutritional statuses. Children with overweight or obesity were guided to lose weight to achieve a healthier weight status and a thinner body size. Children of a normal weight with a BMI higher than the median were guided to understand the difference between their current weight and the cutoff values of overweight and obesity, keep their body size and actively control the rapid growth of their weight. Children of a normal weight with a BMI lower than the median, or those underweight, were taught to develop healthy eating and exercise habits, rather than control their weight or pursue excessive slimness.