Discussion
obesity
OBESITY, CHILDHOOD OBESITY
The present study revealed that the readiness of intervention communities increased between baseline and follow-up and received to the preparation stage. Furthermore, the dimension-specific readiness stages of interventions significantly improved for four CRM dimensions related to community efforts and programs, community knowledge about the existing efforts and childhood obesity issue, and leadership. At the same time, the readiness score of the control communities significantly decreased, although their overall stage of readiness remained unchanged, corresponding to the preplanning stage. Furthermore, the dimension-specific readiness scores of control communities significantly decreased on three of six dimensions related to the community effort, knowledge of efforts, and resources. Also, a sex-dependent increasing and declining CR change was observed in intervention and control communities, such that the girls’ schools showed a more remarkable improvement in interventions and less decline in controls.Although most studies have measured CR to determine the current state of the community for the prevention of childhood obesity [The CRITCO study, as the first multilevel, multisector readiness-based prevention effort among developing countries, resulted in the readiness increment of intervention communities by 0.48, suggesting that the intervention successfully improved CR by one level, from the preplanning to the preparation stage. This result is consistent with findings from a previous systematic review that suggested an increase between 0.5 and 1 in CR levels per year intervention [The present study showed that the readiness stage of intervention sites increased significantly to a higher level for the dimensions related to community efforts, knowledge, and leadership. Although similar to the other readiness-based obesity prevention efforts, most conducted efforts focused on promoting healthy eating and physical activity [In the present study, although the readiness stage of the control group remained unchanged, their total and dimension-specific readiness scores of the three dimensions decreased significantly between baseline and follow-up. This finding is in line with the data from a controlled obesity prevention study that showed the readiness of most comparison communities decreased between pre-and post-intervention [In the present study, a sex-dependent relationship was observed in the CR change, such that the readiness of girls’ schools compared to boys’ schools was accompanied by a greater increase and a smaller decrease in interventions and controls. Due to the various sex disparities in weight-related cultural beliefs and perceptions, it is not far from expected that the leaders and community members were more concerned and motivated to be involved in obesity prevention efforts for girls rather than boys [