IMB-model Based Community Intervention Trial Among Overweight And Obesity Students

ObjectivesThe prevalence of overweight and obesity in children and adolescents has increased rapidly.Obesity,which has serious consequences on students' health,has become a major public health problem in China and globally.There is evidence on positive behavioral interventions for preventing obesity,however,the long-term effectiveness of these interventions remain questionable.This study aimed to know the obesity prevalence among school-age students in Minhang District in Shanghai and use the Information-Motivation-Behavioral Skills(IMB)Model to examine the effectiveness of such interventions on obesity intervention.MethodsAll students in Longbai community of Minhang District in Shanghai underwent physical examination during the period of December 2015.Height,weight,waist circumference,hip circumference and body fat were measured.Then we selected three primary schools and two secondary schools as the intervention group and the other three primary schools and two secondary schools as the control group by cluster random sampling methods.For the interventional trial,we included the students who met the diagnostic criteria as overweight or obesity by the Body Mass Index(BMI)standard defined by the Working Group on Obesity in China.We excluded students with secondary obesity or with severe dysfunction of body or participated in other interventions in a year or intended to in one year in the future and excluding the first grade,fifth grade and ninth-grade students.A total of 680 students were enrolled in the intervention group and 412 students in the control group.Students in the intervention group was given the IMB model-based behavioral interventions during the period of January 2015 to December 2015,including four aspects of information,motivation,behavioral skills and behavior.Students in the control group was given the existing community health management programs.All students needed to do questionnaires and physical examinations before and after intervention to assess the effect.If p<0.05,it means statistically significant.Results1.The rate of overweight and obesity among students in Shanghai Minhang District.A total of 5942 students(3250 boys and 2692 girls)underwent initial survey and physical examination and their mean age was 9.9 years old with standard deviation of 2.1 years.Among all students,843(14.2%)were overweight students and 747(12.6%)were obese.Among boys,there were 536(16.5%)overweight and 515(15.8%)obese.Among girls,307(11.4%)overweight and 232(8.6%)obese.The overweight and obesity rates were higher than in boys than girls(p<0.05).The prevalence of obesity was higher than in primary schools(13.2%)than in middle schools(10.5%)(p<0.05).2.Obesity-related information,motivation,behavioral skills and behavior among overweight and obese studentsA total of 1092 overweight and obesity students underwent the assessment of obesity-related information,motivation,behavioral skills and behavior.The mean score was 3.5 ± 1.8 points(out of 8 points)for information,9.1 ± 2.5 points(out of 13 points)for motivation,4.7 ± 1.3 points(out of 6 points)for behavioral skills,and 6.9 ± 1.6 points(out of 9 points)for behaviors,respectively.The overall score was 24.1 ± 4.8 points(out of 36 points).The question "obesity-related factors" had the lowest score with only 3.9% correct rate,followed by "whether the school had carried out obesity-related courses" which had only 22.7% beneficial motivation rate.The overall score of obesity-related information,motivation,behavioral skills and behavior among boys was 24.0±4.9 points with 3.5±1.8 points for information,9.0±2.4 points for motivation,4.6±1.3 points for behavioral skills,6.8±1.6 points for behavior.On the other hand,the overall score was 24.3±4.5 points among girls with 3.3±1.7 points for information,9.3±2.5 points for motivation,4.8±1.3 points for behavioral skills,6.9±1.6 points for behavior.The differences between boys and girls were not significant(p>0.05).3.The effect of obesity intervention based on IMB model among studentsThe intervention group included 680 overweight and obese students(348 for overweight and 332 for obesity).The control group included 412 students(215 for overweight and 197 for obesity).Differences in gender,age,proportion of overweight and obesity students between the two groups had no significance(p>0.05).After one year intervention,the height,weight,BMI,waist circumference,hip circumference and waist-hip ratio(WHR)have increased and body fat has declined both in intervention group and control group with significance(p<0.05).But the control group increased 0.8kg more in weight and 0.4kg/m2 more in BMI than intervention group.And the intervention group declined(17.5%)more in the rate of overweight and obesity than the control group(10.9%)with significance(p<0.05).Both the students in intervention group and control group have increased in the total score of obesity-related information,motivation,behavioral skills and behavior with significance(p<0.05).The intervention group increased from 24.8 to 27.1 points,the control group increased from 23.0 to 23.7 points,but the intervention group increased more than the control group with significance(p<0.05).Only the score of obesity-related motivation in control group increased from 8.6 to 9.1 points with significance(p<0.05).However all the score of obesity-related information,motivation and behavior in intervention group increased with significance(p<0.05).The score increased from 3.5 to 4.2 points for information,from 9.4 to 10.7 points for motivation,from 7.0 to 7.2 points for behavior and the changing in motivation was greater than the control group(p<0.05).ConclusionsThrough this study,we found that the overweight,obesity prevalence among students in surveyed community has reached the level of developed countries.And the students had a poor obesity-related information,lacking of systematic knowledge of obesity.The performance in obesity-related motivation,behavioral skills and behavior was also not good.Through the IMB model-based community intervention,the intervention group were significantly better than the control group both in the physical indicators and obesity-related information,motivation and behavior aspects.In summary,we should solve the obesity problem among children and adolescents as soon as possible.The IMB model based comprehensive obesity intervention in community is an effective solution.