| Objective:Overweight and obesity of children have become one of the most serious public health problems in the 21 st century.From 1975 to 2016,the number of obese children around the world continued to increase,and the prevalence of obesity and overweight among children and adolescents increased from 4% to 18%.China is in a period of economic transition,people's lifestyle,living environment and health awareness are changing rapidly.Overweight and obesity have become one of the most prominent problems among primary and middle school students in our country.The detection rate of overweight and obesity among students of all ages continues to increase.From 1985 to2014,the prevalence rate of overweight and obesity among children and adolescents aged7-17 in China increased from 1.24% to 19.4%,the obesity rate and overweight rate of boys increased by 17.71% and 17.54% respectively,and the obesity rate and overweight rate of girls increased by 6.47% and 16.43% respectively,which is higher than that of developed countries in the same period.China has developed into the "second largest obese country" in the world,and overweight and obesity among children and adolescents in China have entered the epidemic stage.Childhood obesity can increase the risk of a variety of chronic diseases in children and adolescents.Not only that,obesity also has a great impact on children's learning ability,mental health and social function.Therefore,understanding the current situation and influencing factors of overweight and obesity among school-age children and adolescents plays a very important role in improving obesity,promoting students' health,achieving the overall goal of national health and implementing the strategy of strengthening the country with talents.Lots of studies have shown that children's overweight and obesity are the result of heredity and environment,in addition to being affected by biological genetic factors such as age,sex,birth status,parental heredity.Dietary behavior,physical activity,sleep and other behavioral lifestyle factors may also play an important role.The model of knowledge,belief and behavior(Knowledge,Attitude,Belief,Practice,KABP or KAP)represents the management role of knowledge,attitude and behavior in promoting personal health behavior change.Compared with other developed countries,primary and middle school students in China not only face the problem of obesity,but also lack of knowledge about health.In addition,with the development of social economy and the change of diet,teenagers are more and more inclined to eat all kinds of soft drinks and high-sugar,high-fat and high-energy foods,and gradually develop the habit of being sedentary with the progress of science and technology.In addition,parents' cognition,attitude and behavior habits towards obesity always affect the development of their children's behavior and life style.With the rising number of overweight and obesity among children and adolescents around the world,the World Health Organization and western countries spare no effort to intervene and manage childhood obesity.In the active development of intervention methods for childhood obesity in China,it is found that school is an important intervention channel for childhood obesity,and the establishment of a healthy school environment has high costs and benefits.Based on the KAP theoretical model,we can carry out health education on overweight and obesity knowledge to students and parents,so that they can form a positive attitude after acquiring knowledge,and then dominate behavior,which can effectively reduce students' weight.However,at present,there are few studies on the comprehensive intervention of childhood obesity in China based on the school environment.Therefore,this study used a cross-sectional questionnaire to evaluate the epidemic characteristics of overweight and obesity among primary and middle school students aged 7-17 and the epidemiological distribution of obesity knowledge,belief and practice among students and parents.The purpose of this study is to explore the influencing factors of overweight and obesity in primary and middle school students from the aspects of natural condition,birth status,family income,parental genetic factors,KAP.The comprehensive intervention measures of obesity among primary and middle school students based on KAP model were carried out,the intervention effects are evaluated from indicators such as body morphology,biochemical indicators and obesity-related incidence,and the comprehensive intervention measures are used to improve children and adolescents.Exploring the effect of comprehensive intervention measures on improving obesity in children and adolescents.Scientific basis is provided for preventing and controlling the occurrence and development of overweight and obesity in primary and secondary school students in the future,promoting students' health,and achieving the overall goal of national health.Methods:This research carried out on-site surveys successively from 2012 to 2014,collecting data on individuals,families and schools.Completed questionnaire surveys on factors related to overweight and obesity among students.Physical examination and biochemical tests such as venous blood glucose and blood lipids of some samples,and establish a database.In this study,a stratified cluster random sampling method was used to select 12 primary and secondary schools in urban and rural areas of Fuxin and Liaoyang in the demonstration base of Liaoning Province to conduct cross-sectional and randomized controlled trials.The study conducted physical examinations(height,weight,waist,hips)from October 2013 to November 2013.The baseline physical examination number was10,152,and the valid data was 9,982;a questionnaire survey was conducted from November 2013 to January 2014,Including students and parents,including general information,birth status,parent education level,parental obesity,parental chronic disease,obesity-related knowledge,obesity-related attitudes,obesity-related diet,exercise sleep behavior,etc.,effective research The subjects were 8,850 students,of which 2,400 students were randomly selected to be tested for blood biochemical indicators,and the effective samples were 2,247 cases.The students in the cross-sectional survey were randomly divided into an intervention group and a control group at a ratio of 1:1 to participate in the intervention study.The intervention school implemented a comprehensive intervention from November 2013 to April 2014 and recovered 8,590 valid questionnaires,with an effective recovery rate of 97.1%.In this study,Epi Data database was used for data entry and management,and data entry was conducted by double-entry verification.IBM SPSS Statistics 21.0 software was used for statistical analysis of the research data.The measurement data were tested for normality.The measurement data conforming to the normal distribution were described in the form of mean ± standard deviation;the measurement data not conforming to the normal distribution were described in the form of median(25% digit and 75% digit);the counting data were described in terms of the number of cases and percentage.Inter-group comparison of measurement data conforming to normal distribution was conducted by independent sample T test or single factor ANOVA;inter-group comparison of measurement data not conforming to normal distribution was conducted by non-parametric test;inter-group comparison of counting data was conducted by Chi-square test.In the multivariate analysis,multiple linear /Logistic regression analysis was used.AMOS 26.0 software was used to construct KAP structural equation models related to obesity for the whole population,boys and girls,and maximum likelihood method was used for parameter estimation and Bootstrap test to analyze the interaction between latent variables.All statistical analysis results were taken as P<0.05.The standard of statistical significance.Result:1.The cross-sectional survey results show that the overweight rate of children and adolescents in this study was 14.4%,and the obesity rate was 14.2%.The overall rate of overweight and obesity for boys(34.1%)was significantly higher than that for girls(22.7%),and the overall rate of overweight and obesity for urban students(35.9%)Significantly higher than rural students(22.1%);Multivariate analysis found that school period(junior high school vs.elementary school)(OR=0.74,95%CI=0.57-0.96),place of residence(urban vs.rural)(OR=1.57,95%CI=1.29-1.92),father's education(university vs.elementary school)(OR=0.59,95%CI=0.40-0.88),Mother's education(university vs.elementary school)(OR=1.69,95%CI=1.09-2.61),father's obesity(OR=1.38,95%CI=1.00-1.89)are the influencing factors of male overweight;school period(junior high school vs.elementary school)(OR=0.39,95%CI=0.29-0.51),place of residence(urban vs.rural)(OR=1.74,95%CI=1.35-2.23),high birth weight(OR=1.23,95%CI=1.02-1.48),and father's obesity(OR=1.52,95%CI=1.10-2.11)are the influencing factors of girls' overweight;residence(urban vs.rural)(OR =2.18,95%CI=1.79-2.67),high birth weight(OR=1.26,95%CI=1.07-1.49),and father's obesity(OR=2.23,95%CI=1.66-2.99),Mother's obesity(OR=1.91,95%CI=1.24-2.95)are the influencing factors of male obesity;school period(high school vs.elementary school)(OR=0.66,95%CI=0.47-0.94),place of residence(urban vs.rural)(OR=1.67,95%CI=1.28-2.16),only child(no vs.yes)(OR=0.74,95%CI=0.57-0.95),high birth weight(OR=1.69,95%CI=1.38-2.07),father's obesity(OR=2.24,95%CI=1.63-3.08),Mother's obesity(OR=2.42,95%CI=1.60-3.66)is an influencing factor of female obesity.2.A multi-factor analysis of knowledge,belief,behavior and behavior found that the main factors affecting primary and secondary school students' overweight are gender(male vs.female)(OR=1.374),school period(high school vs.elementary school)(OR=1.95,95%CI=1.52-2.51),and residence(urban vs.rural)(OR=1.40,95%CI=1.16-1.68),obesity hazard(larger vs.smaller)(OR=0.82,95%CI=0.67-0.998)),weight change willingness(want to change vs.don't want to)(OR=1.62,95%CI=1.34-1.97)and parents' perception of their children's weight(wrong vs.right)(OR=6.34,95%CI=5.43-7.40);the main factor affecting primary and secondary school students' obesity is gender(male vs.female)(OR=1.77,95%CI=1.50-2.08),School period(high school vs.elementary school)(OR=0.48,95%CI=0.36-0.66),place of residence(OR=1.70,95%CI=1.39-2.09),birth weight(OR=1.44,95%CI=1.23-1.69),father's obesity(OR=2.05,95%CI=1.60-2.63),mother's obesity(OR=1.90,95%CI=1.34-2.70),milk intake(less vs.more)(OR=1.22,95%CI=1.03-1.44),eating speed(fast vs.slow)(OR=2.32,95%CI=1.84-2.93),self-conscious weight satisfaction(satisfied vs.dissatisfied)(OR=0.28,95%CI=0.22-0.34),weight change willingness(want to change vs.do not want)(OR=2.72,95%CI=2.14-3.47)and parents' perception of their children's weight(wrong vs.right)(OR=6.22,95%CI=5.26-7.35).The results of structural equation model show that knowledge has a direct effect on attitude in the whole population and in the male and female groups,and the effect value is 0.44 for the whole population,0.49 for the male and 0.45 for the female.Knowledge has a direct effect on behavior,and the effect value is 0.32 for the whole population,0.41 for boys and 0.33 for girls.Attitude has a direct effect on behavior,with an effect value of 0.19 for the whole population,0.08 for boys and 0.21 for girls.The indirect effect value between knowledge and behavior is 0.08(0.07-0.10)for the whole population,0.04(0.02-0.06)for boys and 0.10(0.08-0.13)for girls,suggesting that knowledge and attitude both have a positive effect on behavior change,and knowledge can also have an indirect effect on behavior through attitude.Attitude plays a partial mediating role between knowledge and behavior.It is considered that the model has good fitting effect and can be used as a reference model.3.The intervention study found that the height,weight,waist circumference and BMI of the intervention group and the control group increased significantly during the intervention period(P<0.05).The increase of body weight,waist circumference,BMI,waist-to-height ratio,triglyceride and low-density lipoprotein of the intervention group was less than that in the control group,the difference was statistically significant(P<0.05),and the levels of blood glucose,cholesterol,and high-density lipoprotein in the intervention group decreased after intervention.The overweight detection rates in the intervention group and control group after intervention were 13.4%and 15.2%,respectively.The overweight rate in the intervention group decreased by0.7%,and there was a statistical difference between the groups(P<0.05);After the intervention,the awareness rate of obesity-related knowledge in the intervention group increased,the daily consumption of fruits and vegetables increased,and the daily beverage and meat consumption decreased.In the past seven days,the number of breakfast days and snacks and fried foods decreased.the number of days for eating out increased,the amount of daily exercise increased,the time spent sitting and lying down doing homework decreased,but the screen The use time increases,the eating speed decreases,and the difference is statistically significant(P<0.05).Conclusion:1.The problem of overweight and obesity among primary and middle school students in this study is relatively serious.Boy obesity,adolescent obesity and urban obesity are more prominent.Urban adolescent boys and adolescents should be paid attention as high-risk groups;2.Obesity in children and adolescents is affected by various genetic and environmental factors such as birth weight,hypertension,parental obesity,eating speed,individual attitudes towards obesity,and whether parents can correctly perceive the weight of their children,especially parents who misunderstand the weight of their children.It is highly related to the outcome of children's obesity and should be taken seriously;individuals can gradually change their attitudes towards obesity by acquiring obesity-related knowledge,and thus cause behavior changes;3.The school-based comprehensive intervention on obesity,knowledge,belief and behavior has a better prevention and treatment effect on school-age children's overweight.The intervention measures have a certain regulatory effect on the physical indicators and biochemical indicators of children and adolescents,and can comprehensively improve children's and adolescents' recognition of obesity.It is known that it has a significant improvement effect on standardizing students' diet and exercise behavior,and its preventive and control effect on obesity needs to be further confirmed. |
PDF Full Text Request