An intervention to promote Healthy Eating and Physical Activity in Lebanese School children: Health-E-PALS a pilot cluster randomised controlled trial

Abstract

Aim and objectives: The purpose of this study was to develop, implement and evaluate the effectiveness of a multicomponent school-based intervention that focused on promoting healthy eating and physical activity with school children (aged 9 to 11 years) in Lebanon, in order to prevent childhood obesity.
Methods: A school-based intervention adapted to the culture of Lebanese and Arab populations and based on the constructs of the Social Cognitive Theory was developed. The intervention consisted of three components: classroom curriculum, food service, family involvement. Eight schools were selected from two different communities (high and low socioeconomic status) in Beirut and were randomly assigned (by a toss of a coin) to either the intervention or control group. Students aged nine to eleven years in intervention schools were exposed to the intervention components for three months. Students in control schools received their usual school curriculum. Anthropometric measurements, questionnaires on determinants of behavioural change, eating and physical activity habits were completed by the students in both groups at baseline and post intervention. Focus group interviews were conducted with students, teachers and parents in intervention schools at the end of the study.
Results: Changes were observed based on self-report measures. Daily breakfast intake increased significantly in the intervention group compared with the control group (3.5 times more p<0.001). Students in the intervention group reported consuming significantly less chips and sweetened drinks at post-test compared with controls (86% & 88% less respectively p<0.001). There was no difference in physical activity and screen time habits and no changes in BMI between groups at post intervention. Knowledge and self-efficacy scores increased for the intervention (+2.8 & 1.7 points respectively p<0.001) but not for the control group. Interview data from focus groups showed that the programme was generally well accepted; students benefited in a pleasurable way and made attempts to change their eating and physical activity habits. Limitations for better outcomes include the length of the programme and the school environment.
Conclusion: “Health-E-PALS” (Healthy Eating and Physical Activity in Lebanese School children) is a promising innovative, theory-based, culturally sensitive intervention to promote Healthy Eating and Physical Activity in Lebanese school children with a regional perspective.