Purpose: This study aimed to develop a program to promote obesity prevention behaviors for pre-schoolers and to confirm the effectiveness of the program in Korea. Methods: The program comprised 8 sessions for 4 weeks including combined classroom lectures and physical activities. A non-equivalent control group pre-post test study design was used, and seventy two children, aged 5 to 6 years (experimental group: 33, control group: 39) and their parents participated in the study. To examine the effectiveness of the program, children's knowledge, intake of sugar-added beverages and fruits & vegetables, time of outdoor play and screen time, and parental self-efficacy were measured. Data were analyzed with SPSS/WIN ver. 22.0 and R 4.0.2, using descriptive analysis, chi-square test, Fisher's exact test, the independent t-test, and Analysis of covariance (ANCOVA). Results: The results showed that the experimental group reported significantly increased knowledge (p < .001) and longer time of outdoor play on weekends (p = .033). However, there were no significant differences in the intake of sugar-added beverages and fruits & vegetables, screen time, and parental self-efficacy in the two groups. Conclusion: This study confirms the applicability of an obesity prevention intervention at kindergartens in Korea. The results can be used as basic data for the study of childhood obesity prevention in Korea.
de Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. The American Journal of Clinical Nutrition. 2010;92(5):1257-1264. https://doi.org/10.3945/ajcn.2010.29786
World Health Organization (WHO). Population-based approaches to childhood obesity prevention [Internet]. Geneva: WHO; c2012 [cited 2018 Sep 1]. Available from: https://www.who.int/dietphysicalactivity/childhood/approaches/en/.
Organisation for Economic Co-operation and Development (OECD). 2014 OECD Statisics Health status [Internet]. Paris: OECD; c2014 [cited 2018 Sep 1]. Available from: https://stats.oecd.org/.
Graversen L, Sorensen TI, Petersen L, Sovio U, Kaakinen M, Sandbaek A, et al. Preschool weight and body mass index in relation to central obesity and metabolic syndrome in adulthood. PLoS One. 2014;9(3):e89986. https://doi.org/10.1371/journal.pone.0089986
De Bourdeaudhuij I, Verbestel V, De Henauw S, Maes L, Huybrechts I, Marild S, et al. Behavioural effects of a community-oriented setting-based intervention for prevention of childhood obesity in eight European countries. Main results from the IDEFICS study. Obesity Reviews. 2015;16 Suppl 2:30-40. https://doi.org/10.1111/obr.12347
Gibson EL, Kreichauf S, Wildgruber A, Vogele C, Summerbell CD, Nixon C, et al. A narrative review of psychological and educational strategies applied to young children's eating behaviours aimed at reducing obesity risk. Obesity Reviews. 2012;13 Suppl 1:85-95. https://doi.org/10.1111/j.1467-789X.2011.00939.x
Sung KS, Yoon YM, Kim EJ. Meta-analysis of the effects of obesity management program for children. Child Health Nursing Research. 2013;19(4):262-269. https://doi.org/10.4094/chnr.2013.19.4.262
Kim S, Sung E, Yoo S. Evidence of interventions for preventing obesity of children and adolescents using existing systematic reviews and meta-analyses. Korean Journal of Health Promotion. 2016;16(4):231-250. https://doi.org/10.15384/kjhp.2016.16.4.231
Summerbell CD, Moore HJ, Vogele C, Kreichauf S, Wildgruber A, Manios Y, et al. Evidence-based recommendations for the development of obesity prevention programs targeted at preschool children. Obesity Reviews. 2012;13 Suppl 1:129-132. https://doi.org/10.1111/j.1467-789X.2011.00940.x
de Jong E, Visscher TL, HiraSing RA, Heymans MW, Seidell JC, Renders CM. Association between TV viewing, computer use and overweight, determinants and competing activities of screen time in 4- to 13-year-old children. International Journal of Obesity. 2013;37(1):47-53. https://doi.org/10.1038/ijo.2011.244
Fitzpatrick C, Pagani LS, Barnett TA. Early childhood television viewing predicts explosive leg strength and waist circumference by middle childhood. International Journal of Behavioral Nutrition and Physical Activity. 2012;9:87. https://doi.org/10.1186/1479-5868-9-87
Mendoza JA, Zimmerman FJ, Christakis DA. Television viewing, computer use, obesity, and adiposity in US preschool children. International Journal of Behavioral Nutrition and Physical Activity. 2007;4:44. https://doi.org/10.1186/1479-5868-4-44
Rey-Lopez JP, Vicente-Rodriguez G, Biosca M, Moreno LA. Sedentary behaviour and obesity development in children and adolescents. Nutrition, Metabolism, and Cardiovascular Diseases. 2008;18(3):242-251. https://doi.org/10.1016/j.numecd.2007.07.008
Hockenberry MJ, Wilson D, Rodgers CC. Wong's essentials of pediatric nursing. 10th ed. St. Louis (MO): Elsevier; 2016. p. 1-1064.
Taylor RW, Grant AM, Goulding A, Williams SM. Early adiposity rebound: Review of papers linking this to subsequent obesity in children and adults. Current Opinion in Clinical Nutrition & Metabolic Care. 2005;8(6):607-612. https://doi.org/10.1097/01.mco.0000168391.60884.93
Ju HO, Park CG. Estimation for the time of adiposity rebound in Korean children and the effects of breast feeding on BMI before adiposity rebound. The Korean Journal of Obesity. 2011;20(1):8-15.
Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs (NJ): Prentice-Hall; 1986. p. 23-28.
Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0-5 year olds: An updated systematic review of the literature. Obesity. 2010;18 Suppl 1:S27-S35. https://doi.org/10.1038/oby.2009.429
Skouteris H, McCabe M, Swinburn B, Newgreen V, Sacher P, Chadwick P. Parental influence and obesity prevention in pre-schoolers: A systematic review of interventions. Obesity Reviews. 2011;12(5):315-328. https://doi.org/10.1111/j.1467-789X.2010.00751.x
Ward DS, Welker E, Choate A, Henderson KE, Lott M, Tovar A, et al. Strength of obesity prevention interventions in early care and education settings: A systematic review. Preventive Medicine. 2017;95 Suppl:S37-S52. https://doi.org/10.1016/j.ypmed.2016.09.033
Coleman KJ, Ocana LL, Walker C, Araujo RA, Gutierrez V, Shordon M, et al. Outcomes from a culturally tailored diabetes prevention program in Hispanic families from a low-income school: Horton Hawks Stay Healthy (HHSH). The Diabetes Educator. 2010;36(5):784-792. https://doi.org/10.1177/0145721710377360
Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, et al. Early life risk factors for obesity in childhood: Cohort study. BMJ. 2005;330(7504):1357. https://doi.org/10.1136/bmj.38470.670903.E0
Dudley DA, Cotton WG, Peralta LR. Teaching approaches and strategies that promote healthy eating in primary school children: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2015;12:28. https://doi.org/10.1186/s12966-015-0182-8
Yun S, Lim D, Oh K, Moon J, Kim JH. Development of the 2017 Korean National Growth Charts for children and adolescents. Public Health Weekly Report. 2018;11(25):813-820.
World Health Organization Regional Office for the Western Pacific. The Asia-Pacific perspective: Redefining obesity and its treatment. Sydney: Health Communications Australia; 2000. p. 1-55.
Huybrechts I, Bornhorst C, Pala V, Moreno LA, Barba G, Lissner L, et al. Evaluation of the Children's Eating Habits Questionnaire used in the IDEFICS study by relating urinary calcium and potassium to milk consumption frequencies among European children. International Journal of Obesity. 2011;35 Suppl 1:S69-S78. https://doi.org/10.1038/ijo.2011.37
Lanfer A, Hebestreit A, Ahrens W, Krogh V, Sieri S, Lissner L, et al. Reproducibility of food consumption frequencies derived from the Children's Eating Habits Questionnaire used in the IDEFICS study. International Journal of Obesity. 2011;35 Suppl 1:S61-S68. https://doi.org/10.1038/ijo.2011.36
Hinkley T, Salmon J, Okely AD, Crawford D, Hesketh K. Preschoolers' physical activity, screen time, and compliance with recommendations. Medicine and Science in Sports & Exercise. 2012;44(3):458-465. https://doi.org/10.1249/MSS.0b013e318233763b
Mouratidou T, Mesana MI, Manios Y, Koletzko B, Chinapaw MJ, De Bourdeaudhuij I, et al. Assessment tools of energy balance-related behaviours used in European obesity prevention strategies: Review of studies during preschool. Obesity Reviews. 2012;13 Suppl 1:42-55. https://doi.org/10.1111/j.1467-789X.2011.00958.x
Ra JS, Chae SM. Factors influencing maternal support for physical activity of preschool children. Child Health Nursing Research. 2014;20(1):30-38. https://doi.org/10.4094/chnr.2014.20.1.30
Sarker H, Anderson LN, Borkhoff CM, Abreo K, Tremblay MS, Lebovic G, et al. Validation of parent-reported physical activity and sedentary time by accelerometry in young children. BMC Research Notes. 2015;8:735. https://doi.org/10.1186/s13104-015-1648-0
Verbestel V, De Henauw S, Bammann K, Barba G, Hadjigeorgiou C, Eiben G, et al. Are context-specific measures of parental-reported physical activity and sedentary behaviour associated with accelerometer data in 2-9-year-old European children? Public Health Nutrition. 2015;18(5):860-868. https://doi.org/10.1017/S136898001400086X
Bohman B, Rasmussen F, Ghaderi A. Development and psychometric evaluation of a context-based parental self-efficacy instrument for healthy dietary and physical activity behaviors in preschool children. International Journal of Behavioral Nutrition and Physical Activity. 2016;13(1):110. https://doi.org/10.1186/s12966-016-0438-y
Bohman B, Ghaderi A, Rasmussen F. Psychometric properties of a new measure of parental self-efficacy for promoting healthy physical activity and dietary behaviors in children. European Journal of Psychological Assessment. 2013;29(4):291-298. https://doi.org/10.1027/1015-5759/a000159
Bartholomew Eldredge LK, Markham CM, Ruiter RAC, Fernandez ME, Kok G, Parcel GS. Planning health promotion programs: An intervention mapping approach. 4th ed. San Francisco (CA): Jossey-Bass; 2016. p. 1-704.
De Craemer M, De Decker E, De Bourdeaudhuij I, Verloigne M, Duvinage K, Koletzko B, et al. Applying the Intervention Mapping protocol to develop a kindergarten-based, family-involved intervention to increase European preschool children's physical activity levels: The ToyBox-study. Obesity Reviews. 2014;15 Suppl 3:14-26. https://doi.org/10.1111/obr.12180
Verbestel V, De Henauw S, Maes L, Haerens L, Marild S, Eiben G, et al. Using the intervention mapping protocol to develop a community-based intervention for the prevention of childhood obesity in a multi-centre European project: The IDEFICS intervention. International Journal of Behavioral Nutrition and Physical Activity. 2011;8:82. https://doi.org/10.1186/1479-5868-8-82
Kim IO, Lee JH. A study on the development of a nutrition education program and measurement of it's effects. Korean Journal of Child Health Nursing. 2003;9(1):46-56.
Hong MA, Choi MS, Han YH, Hyun T. Effect of nutrition education program developed by a public health center on preschool children's nutrition knowledge and dietary habits and the parent's dietary attitudes. Korean Journal of Community Nutrition. 2010;15(5):593-602.
Van Cauwenberghe E, Jones RA, Hinkley T, Crawford D, Okely AD. Patterns of physical activity and sedentary behaviour in preschool children. International Journal of Behavioral Nutrition and Physical Activity. 2012;9:138. https://doi.org/10.1186/1479-5868-9-138
van Stralen MM, te Velde SJ, van Nassau F, Brug J, Grammatikaki E, Maes L, et al. Weight status of European preschool children and associations with family demographics and energy balance-related behaviours: A pooled analysis of six European studies. Obesity Reviews. 2012;13 Suppl 1:29-41. https://doi.org/10.1111/j.1467-789X.2011.00959.x
Sigmundova D, Sigmund E, Badura P, Vokacova J, Trhlikova L, Bucksch J. Weekday-weekend patterns of physical activity and screen time in parents and their pre-schoolers. BMC Public Health. 2016;16(1):898. https://doi.org/10.1186/s12889-016-3586-8
Alhassan S, Nwaokelemeh O, Lyden K, Goldsby T, Mendoza A. A pilot study to examine the effect of additional structured outdoor playtime on preschoolers' physical activity levels. Child Care in Practice. 2013;19(1):23-35. https://doi.org/10.1080/13575279.2012.712034
Cosco NG, Moore RC, Smith WR. Childcare outdoor renovation as a built environment health promotion strategy: Evaluating the preventing obesity by design intervention. American Journal of Health Promotion. 2014;28(3 Suppl):S27-S32. https://doi.org/10.4278/ajhp.130430-QUAN-208
Rolling TE, Hong MY. The effect of social cognitive theory-based interventions on dietary behavior within children. Journal of Nutritional Health and Food Science. 2016;4(5):1-9. https://doi.org/10.15226/jnhfs.2016.00179
Sisson SB, Broyles ST, Baker BL, Katzmarzyk PT. Screen time, physical activity, and overweight in U.S. youth: National Survey of Children's Health 2003. Journal of Adolescent Health. 2010;47(3):309-311. https://doi.org/10.1016/j.jadohealth.2010.02.016
Natale R, Scott SH, Messiah SE, Schrack MM, Uhlhorn SB, Delamater A. Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting. BMC Public Health. 2013;13:78. https://doi.org/10.1186/1471-2458-13-78
Yin Z, Parra-Medina D, Cordova A, He M, Trummer V, Sosa E, et al. Miranos! Look at us, we are healthy! An environmental approach to early childhood obesity prevention. Childhood Obesity. 2012;8(5):429-439. https://doi.org/10.1089/chi.2011.0125
Dwyer J, Needham L, Simpson JR, Heeney ES. Parents report intrapersonal, interpersonal, and environmental barriers to supporting healthy eating and physical activity among their preschoolers. Applied Physiology, Nutrition, and Metabolism. 2008;33(2):338-346. https://doi.org/10.1139/H07-195
Barnett AG, van der Pols JC, Dobson AJ. Regression to the mean: What it is and how to deal with it. International Journal of Epidemiology. 2005;34(1):215-220. https://doi.org/10.1093/ije/dyh299
이 논문을 인용한 문헌 (1)
1. Park, Jiyoung, Hoor, Gill A. Ten, Baek, Seolhyang, Chung, Sochung, Kim, Yang-Hyun, Hwang, Gahui 2021. "The Let's Eat Healthy and Move at School program for adolescents in South Korea: Program design, implementation, and evaluation plan using intervention mapping" CHNR : Child health nursing research, 27(3): 225~242