Cluster randomised trial of a school-community child health promotion and obesity prevention intervention: Findings from the evaluation of fun ‘n healthy in Moreland!
Open accessAbstract
BACKGROUND: Multi-level, longer-term obesity prevention interventions that focus on inequalities are scarce. Fun 'n healthy in Moreland! aimed to improve child adiposity, school policies and environments, parent engagement, health behaviours and child wellbeing. METHODS: All children from primary schools in an inner urban, culturally diverse and economically disadvantaged area in Victoria, Australia were eligible for participation. The intervention, fun 'n healthy in Moreland!, used a Health Promoting Schools Framework and provided schools with evidence, school research data and part time support from a Community Development Worker to develop health promoting strategies. Comparison schools continued as normal. Participants were not blinded to intervention status. The primary outcome was change in adiposity. Repeated cross-sectional design with nested longitudinal subsample. RESULTS: Students from twenty-four primary schools (clusters) were randomised (aged 5-12 years at baseline). 1426 students from 12 intervention schools and 1539 students from 10 comparison schools consented to follow up measurements. Despite increased prevalence of healthy weight across all schools, after 3.5 years of intervention there was no statistically significant difference between trial arms in BMI z score post-intervention (Mean (sd): Intervention 0.68(1.16); Comparison: 0.72(1.12); Adjusted mean difference (AMD): -0.05, CI: -0.19 to 0.08, p = 0.44). Children from intervention schools consumed more daily fruit serves (AMD: 0.19, CI:0.00 to 0.37, p = 0.10), were more likely to have water (AOR: 1.71, CI:1.05 to 2.78, p = 0.03) and vegetables (AOR: 1.23, CI: 0.99 to 1.55, p = 0.07), and less likely to have fruit juice/cordial (AOR: 0.58, CI:0.36 to 0.93, p = 0.02) in school lunch compared to children in comparison schools. More intervention schools (8/11) had healthy eating and physical activity policies compared with comparison schools (2/9). Principals and schools highly valued the approach as a catalyst for broader positive school changes. The cost of the intervention per child was $65 per year. CONCLUSION: The fun n healthy in Moreland! intervention did not result in statistically significant differences in BMI z score across trial arms but did result in greater policy implementation, increased parent engagement and resources, improved child self-rated health, increased fruit, vegetable and water consumption, and reduction in sweet drinks. A longer-term follow up evaluation may be needed to demonstrate whether these changes are sustainable and impact on childhood overweight and obesity. CLINICAL TRIAL REGISTRATION: ACTRN12607000385448 (Date submitted 31/05/2007; Date registered 23/07/2007; Date last updated 15/12/2009).
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In addition to the 22 studies included in the original review, eight further studies were identified as eligible.
“In addition to the 22 studies included in the original review, eight further studies were identified as eligible.”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [27]
Among 10 studies reporting the proportion of schools implementing a targeted policy, practice, or program versus a minimal or usual practice control, the median unadjusted effect size was 16.2%, ranging from -0.2% to 66.6%.
“For example, among 10 studies reporting the proportion of schools implementing a targeted policy, practice, or program versus a minimal or usual practice control, the median unadjusted effect size was 16.2%, ranging from –0.2% to 66.6%.”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [27]
Seven studies were assessed as low risk of detection bias.
“Seventeen of the included studies were assessed as high risk [26, 28, 37, 41, 43, 44, 46–49, 52, 54–56, 58, 66, 67] and seven studies were assessed as low risk of detection bias [27, 42, 51, 53, 60, 62, 63].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [27]
One study was assessed as high risk of bias for recruitment to cluster due to randomization occurring prior to recruitment and a lack of blinding of recruiters.
“Seven studies were assessed as unclear [26, 37, 38, 41, 42, 46, 67], whilst the remaining study [27] was assessed as high risk of bias due to randomization occurring prior to recruitment and a lack of blinding of recruiters.”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [27]
Three studies were assessed as high risk for baseline imbalance.
“Three studies were assessed as high risk [26, 27, 42], while the remaining study [54] was at unclear risk of bias due to baseline imbalance.”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [27]
Among studies that assessed changes in the implementation of a physical activity policy, practice, or program, effects were modest with median effect sizes ranging from no change (-0.2%) in Farmer et al. to a change of almost 20% in Sutherland et al.
“Among studies that assessed changes in the implementation of a physical activity policy, practice, or program [27, 41, 60, 64], effects were modest with median effect sizes ranging from no change (–0.2%) in the study by Farmer et al. [41] to a change of almost 20% in the Australian randomized trial by Sutherland et al. [60].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [27]
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- Authors
- Waters, E., Gibbs, L., Tadic, M., Ukoumunne, O. C., Magarey, A., Okely, A. D., de Silva, A., Armit, C., Green, J., O’Connor, T., Johnson, B., Swinburn, B., Carpenter, L., Moore, G., Littlecott, H., & Gold, L.
- Affiliations
- The University of Melbourne (AU)
- University of Exeter (GB)
- Flinders University (AU)
- University of Wollongong (AU)
- Deakin University (AU)
- Cardiff University (GB)
- Corresponding author
- Gibbs, Lisa
- ORCID
- Venue
- BMC Public Health
- Published
- 2017-08-03
- Volume
- 18
- Issue
- 1
- Pages
- 92-92
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC5543738
- OpenAlex
- W2742849343
- Cited by
- 94
- References
- 40
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 7 · 2023: 5 · 2022: 8 · 2021: 25 · 2020: 21 · 2019: 11 · 2018: 8 · 2017: 2
- FWCI
- 10.74
- Type
- journal article
- Language
- en
- Update notices
- erratum (2017-09-22)
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Research Online (University of Wollongong) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Flinders Academic Commons (Flinders University) (submittedVersion)
- Flinders Academic Commons (Flinders University) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Figshare (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion, other-oa)
- ResearchSpace (University of Auckland) (submittedVersion, cc-by)
- Funders
- State Government of Victoria
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- childhood adiposity, school community intervention, elementary school students, school meals, fruit and vegetable intake, school physical activity policy, school health policy, parental involvement, child well-being, health disparities, intervention cost-effectiveness, BMI z-score
- MeSH terms
- Body Weight, Child, Child, Preschool, Cross-Sectional Studies, Drinking, Female, Fruit, Health Promotion, Humans, Male, School Health Services, Urban Population, Vegetables, Victoria, Health Behavior, Exercise, Adiposity, Pediatric Obesity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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