Lifestyle interventions to improve educational attainment in overweight or obese children
INTRODUCTION: Childhood obesity is associated with increased physical and psychosocial co-morbidities, and with lower cognitive function and educational attainment. Clinical guidelines recommend lifestyle interventions (healthy diet, increased physical activity and decreased sedentary behaviour) for the treatment of childhood obesity. Lifestyle interventions are known to benefit cognitive function and educational attainment in normal weight children. However, it is not known whether the same benefits occur when lifestyle interventions are used to treat overweight and obese children. AIM & OBJECTIVES: The aim of this thesis was to assess the effect of lifestyle interventions on educational attainment in overweight and obese children in three studies: Objective 1: Assess the efficacy of lifestyle interventions for improving educational attainment. Objective 2: Establish the feasibility of assessing the effectiveness of a childhood primary care weight management programme on educational attainment. Objective 3: Investigate the potential mechanisms for how lifestyle interventions for weight management might benefit educational attainment of overweight children. METHODS: Study 1: Systematic (Cochrane) review and meta-analysis of randomised controlled trials of single or multicomponent lifestyle interventions in children aged 3-18 years. Study 2: Quasi-experimental study linking childhood weight management data of children 5-15 years with education data from local education authorities in Scotland. Study 3: Qualitative study designed to gain insight into overweight and obese children’s and their parents’ perceptions and experiences in school and weight management programme obtained from focus groups and interviews. RESULTS: Study 1: The systematic review included six studies of 674 overweight and obese children and adolescents. Findings indicated that school-based healthy lifestyle education combined with nutrition interventions can produce small improvements in overall school attainment. Single component physical activity interventions produced small improvements in mathematics attainment and associated cognitive skills (executive function, and working memory). There was no evidence of an effect of any lifestyle intervention on reading, vocabulary and language attainment, attention, inhibitory control, and simultaneous processing. Study 2: Cross-sectorial administrative data-linkage was shown to be feasible. This pilot study showed no evidence of a beneficial effect of a primary care child weight management programme on reading, writing and mathematics attainment in overweight and obese children. However, a definitive study to properly assess the effectiveness of lifestyle interventions outside the research environment is clearly feasible in Scotland. Study 3: The themes emerging from focus groups and interviews were body weight related school experiences, attitudes towards school, obesity and school performance, and influence of weight management. Participants perceived that being overweight can benefit educational attainment because a lack of friends means they are less distracted from learning. Low psychosocial well-being experienced by the participants was improved after taking part in a weight management programme. Parents understood this benefit could potentially impact positively on school experiences and attainment in the long-term. CONCLUSION: Given the high prevalence of childhood obesity, educational and cognitive outcomes could be improved, to some extent, in a very large number of school-aged children through increased physical activity and nutrition education intended for weight management. Health policy makers should be aware of these potential additional benefits when promoting physical activity and healthy eating in schools. Childhood weight management programmes exist widely and thus provide an opportunity to evaluate their impact on educational outcomes in the community. Implemented child weight management programmes may benefit from improved recording of routine data and from obtaining participants’ administrative education data to ensure adequate support and supervision of this vulnerable population. In addition, weight management programmes could consider promoting psychosocial well-being of participants to potentially benefit both health and educational outcome. Lifestyle interventions for obese children and adolescents are under-investigated particularly with regard to a) efficacy in clinical and community settings, b) short and long-term effectiveness for improving educational attainment and c) mechanisms of benefit on educational attainment and cognitive function.