ESPE Yearbook of Paediatric Endocrinology

Pediatr Obes. 2025 Apr;20(4):e13171. PMID: 39228329 doi: 10.1111/ijpo.13171

Brief Summary: This non-controlled intervention study evaluated the effects of a school-based healthy eating program in Sri Lanka on food habits and body mass index (BMI) assessed 9 months after intervention. It found sustained positive effects suggesting theintervention as a useful tool to improve nutritional status in low and middle-income countries (LMICs).

Sri Lanka faces the dual problem of a rise in overnutrition with a continued significant incidence of undernutrition. To combat these issues, the authors developed a 3-week school-based intervention to improve knowledge and encourage healthier eating habits among primary school children. This included an age-appropriate motivational storybook illustrating the benefits of a healthy diet and adverse effects of an unhealthy lifestyle and a picture/sticker-based food diary. The program was implemented in 2018-2019 among >1000 grade 1-2 students in 4 state schools in Columbo, Sri Lanka. The study assessed changes in eating habits and change in BMI z-score from baseline after 9 months.

Of the initial 1042 participants, 868 completed the follow-up (83%). Most children had normal BMI at baseline (69%), 17% were underweight, 8% overweight and 6% obese. At follow-up, children who were initially underweight or normal weight showed increases in mean BMI z-score (UW: -2.8 to -2.2, P<0.001 and NW: -0.7 to -0.6, P<0.001), while those who were overweight and obese showed no change in BMI z-score (OW: +1.5 to +1.49, P=0.83 and OB: +2.85 to +2.21, P=0.19). Children with underweight showed a healthy increase toward the median and those with overweight and obesity did not continue to increase. Eating habits were assessed by a one-week food diary and food diary score (FD). Mean FD score 65%at follow-up indicated an improvement of 16.5% in food habits from the baseline score of 51% +/- 23% (P<0.001)

The authors postulate that the success of the program was partly due to the child-friendly, self-motivational and interactive nature of the program with some degree of activity-based parental involvement. While acknowledging the lack of a control group, this short-term educational intervention shows promise for improving nutritional status in young children in LMICs.