Effect of Nutrition and Physical Activity Education Intervention on Weight Management among Adolescents in Secondary Schools in Uasin Gishu County, Kenya
Munyao, Florence Wandia
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Health-related behaviors and attitudes, such as unhealthy eating habits and physical inactivity have been identified as key causative factors of overweight and obesity. Studies to evaluate school-focused interventions on weight management in adolescents in Kenya are limited. The purpose of this study was to determine the effect of a school-focused nutrition and physical activity education intervention on the knowledge, attitudes, dietary patterns and physical activity patterns in relation to body weight among adolescent students 15-18 years old attending day schools in Kenya. This was a Cluster Randomized Controlled Trial in which 4 schools were randomly placed into 2 study groups. Students were randomly assigned to the study groups; 111 per group. The intervention group received 8 lessons each of nutrition education and physical activity education on a weekly basis. Students in the control group received no nutrition and physical activity education lessons from the research team. Data was collected using self-administered questionnaires at baseline, 8 weeks and 6 months post intervention. Key informant interviews were conducted to collect qualitative data. Major dietary patterns were derived from a principal component analysis of reported intake from a Food Frequency Questionnaire. Data was analyzed by use of statistical package for social sciences (SPSS) version 21 for descriptive and inferential statistics. Nutrition and physical activity education resulted in significantly higher improvement in mean knowledge scores in intervention group compared to the control group (T-test: 2.269; p=0.024) at 6 months post intervention. The difference in knowledge change (difference in difference) in the intervention group was significantly higher than the difference in the control group (DID of 0.43; p<0.001). The students mean attitude scores were significantly different at 6 months post intervention (T-test:-6.47; p<0.001). The principal component mean of the healthy dietary pattern was significantly higher in the intervention group compared to the control group (T-test: 1.814; p=0.042). The intensity and levels of physical activity improved in the intervention group as compared to the control group at 8 weeks and 6 months post intervention. Metabolic Equivalent for Task (MET) scores were significantly higher in the intervention group (T-test: -2.36; p=0.019) at 6 months post intervention as compared to the control group. The intervention group had a significantly lower waist circumference at 8 weeks post intervention compared to the control group (T-test: 3.229; p =0.001), but the mean BMI for age Z scores were not significantly different at the same time period (T-test: -0.357; p=0.720), between the study groups. The intervention group had lower mean waist circumference and lower mean BMI for age Z scores in contrast to the control group, at 6 months post intervention. Significant changes in the mean scores of waist circumference (Difference in Difference (DID) of 1.16; p<0.001) and mean BMI for age z scores (DID of 0.66; p<0.001) were noted when baseline and end line mean scores were compared. School focused physical activity and nutrition education can be effective in managing weight among adolescent students and should therefore be encouraged.