Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)

OBJECTIVE To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. DESIGN Cluster randomised controlled trial. SETTING UK primary schools from the West Midlands. PARTICIPANTS 200 schools were randomly selected from all state run primary schools within 35 miles of the study centre (n=980), oversampling those with high minority ethnic populations. These schools were randomly ordered and sequentially invited to participate. 144 eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year 1 pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. 53 schools remained in the trial and data on 1287 (87.7%) and 1169 (79.7%) pupils were available at first followup (15 month) and second follow-up (30 month), respectively. INTERVENTIONS The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mailouts every six months, and termly school led family workshops on healthy cooking skills. OUTCOME MEASURES The protocol defined primary outcomes, assessed blind to allocation, were between arm difference in body mass index (BMI) z score at 15 and 30 months. Secondary outcomes were further anthropometric, dietary, physical activity, and psychological measurements, and difference in BMI z score at 39 months in a subset. RESULTS Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months postbaseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference −0.075 (95% confidence interval −0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was −0.027 (−0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm). CONCLUSIONS The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments. TRIAL REGISTRATION Current Controlled Trials ISRCTN97000586. Introduction Excess weight in childhood is a global problem, affecting around 41 million children under the age of 5 years. In addition to physical and psychosocial health consequences in these early years, childhood For numbered affiliations see end of article. Correspondence to: P Adab p.adab@bham.ac.uk Cite this as: BMJ 2018;360:k211 http://dx.doi.org/10.1136/bmj.k211 Accepted: 19 December 2017 WhAT IS AlReAdy knoWn on ThIS TopIC Comprehensive systematic reviews have suggested that school based interventions could be effective in preventing childhood obesity in high income countries Heterogeneity in intervention components and outcomes limit practical recommendations Furthermore, inconsistent findings in relation to differential effects on subgroups, and impact on inequalities, limited data on potential harms, process measures, and long term effects, as well as lack of data on cost effectiveness, restrict interpretation and wider applicability WhAT ThIS STudy AddS The WAVES study evaluated a theoretically informed, skills based intervention targeting children’s diet and physical activity behaviours through schools and families It did not result in any meaningful effect on adiposity, dietary intake, or physical activity after 15 or 30 months Although such interventions can fulfil the responsibility of schools for wider education, without upstream support they are unlikely to halt the childhood obesity epidemic