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APPLE Project: 2-y findings of a community-based obesity prevention program in primary school–age children^1,2,3

¹ From the Departments of Human Nutrition (RWT, WB, AS, and JIM) and Preventive and Social Medicine (SMW) and the Edgar National Centre for Diabetes Research (KAM and JIM), University of Otago, Dunedin, New Zealand

Background: Developing effective strategies for obesity prevention in children is urgently required.

Objective: We determined the effectiveness of a 2-y controlled community-based intervention to prevent excessive weight gain in 5–12-y-old children by enhancing opportunities for healthy eating and noncurricular physical activity.

Design: Children (n = 730) from 4 intervention and 3 control schools underwent measurements of height, weight, waist circumference, blood pressure, diet, and physical activity at baseline and at 1 and 2 y. Intervention components included nutrition education that targeted reductions in sweetened drinks and increased fruit and vegetable intake and activity coordinators who managed an activity program that focused on noncurricular lifestyle-based activities (eg, community walks).

Results: Body mass index (BMI; in kg/m²) z score was significantly lower in intervention children than in control children by a mean of 0.09 (95% CI: 0.01, 0.18) after 1 y and 0.26 (95% CI: 0.21, 0.32) at 2 y, but the prevalence of overweight did not differ. Waist circumference was significantly lower at 2 y (–1 cm), and systolic blood pressure was reduced at 1 y (–2.9 mm Hg). An interaction existed between intervention group and overweight status (P = 0.029), such that mean BMI z score was reduced in normal-weight (–0.29; 95% CI: –0.38, –0.21) but not overweight (–0.02; 95% CI: –0.16, 0.12) intervention children relative to controls. Intervention children consumed fewer carbonated beverages (67% of control intake; P = 0.04) and fruit juice or drinks (70%; P = 0.03) and more fruit (0.8 servings/3 d; P < 0.01).

Conclusion: A relatively simple approach, providing activity coordinators and basic nutrition education in schools, significantly reduces the rate of excessive weight gain in children, although this may be limited to those not initially overweight. This trial was registered at Australian Clinical Trials Registry as #12605000578606.

Key Words: Obesity prevention • body mass index • BMI • weight gain • child • physical activity • healthy eating