Same BMI, better health: Still fat but a whole lot fitter

An intervention in a Pune school, conducted over a five-year period, had a remarkable impact on students struggling with their expanding waistlines.

Written by Anuradha Mascarenhas | Updated: October 3, 2015 12:00:16 am
bmi, high bmi, body mass index, fat, fat children, fatness in children, obesity, obesity in children, obese, obese children, health news Researchers introduced fitness tests, dietary changes, made sports a scoring subject and banned hawkers from selling fast food. (Source: Express Photo)

Some simple steps introduced in a school, to help the rising number of students struggling with their weight, ended up making them a whole lot fitter.

In a first-of-its-kind study, researchers at Symbiosis school in Pune and KEM hospital tried to find out whether these steps — fitness tests, diet control, grading sports as an academic subject and banning hawkers from selling food items outside the school —helped overweight students in any way.

While the students’ body mass index (BMI) didn’t change much, these steps helped them reduce their waist circumference and get fitter.

Multiple changes were introduced in the ‘culture’ of a school and maintained over a five-year period, between 2006 and 2011, to improve the children’s fitness and health. Researchers found that at the end of the five-year intervention, the students were still fat, but they were much fitter.

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Published online in the October issue of the British Medical Journal (BMJ)’s Archives of Diseases in Childhood, researchers Dr Sheela Bhave, Dr Rajiv Yeravdekar and others have shown that schools need to step up the number of physical education classes and expose students to a variety of fitness tests to ensure children are fit.

In several Indian cities, over 10 per cent of school children are overweight or obese. Factors including a strong emphasis on academic performance (children often attend extra tuition classes outside school), a perception that physical exercise is unimportant, and the popularity of energy-dense foods, contribute to this problem.

At Symbiosis school in Pune, researchers provided intervention to 400 children, who were in Std III and IV in 2005-06. They were assessed over a period of five years, till they reached Std VIII and Std IX, in 2010-2011.

“We increased the number of physical education classes from two to five a week, made it a scoring subject, removed hawkers selling fast food near the school and made school meals a lot healthier,” said Dr Rajiv Yeravdekar, dean of Faculty of Health Sciences, Symbiosis International University, and a researcher in the study.

Researchers also analysed the changes among overweight students over a five-year period in another school in Nashik, where no such intervention was provided.

After five years, students at the Pune school — where interventions were provided — were found to be fitter than their counterparts in Nashik in activities like running, long jumps, sit-ups and push-ups, explained lead researcher Dr Bhave, from the paediatrics department of KEM Hospital and Research Centre. These children reported that they spent less time watching TV and more time playing sports. They also ate fruits more often.

“The intervention did not help reduce the body mass index (BMI) or the prevalence of obesity — as children today have greater access to fast food. However, the waist circumference was significantly lower in children of the Pune school than the ones in the Nashik school. This study proved that it was possible to achieve multiple changes promoting good health in an academically competitive school,” added Bhave.

He added that the parents of the students as well as their teachers seemed to focus more on their academic achievements than their health.

“We realised that parents were more concerned about children’s academic performances than their health and fitness. It took time to implement changes in their physical activities and motivate them to participate. In comparison, dietary improvements were made fairly easily. We hoped that teachers would pass on healthy lifestyle information to the children, but this was unrealistic. They were too busy with academic priorities, upon which they are judged,” said Bhave.

The tests required minimal equipment and were developed by Agashe College of Physical Education in Pune. They were designed to test endurance, cardiovascular fitness, muscular strength and flexibility. They comprised a 9-min walk or run, sit-ups, push-ups, a sit-and-reach test, a shuttle run and a standing long jump.

Other steps included introducing daily pranayam sessions and adding physical education marks to academic reports. Parents received regular fitness reports and opportunities to discuss these individually with nutritionists and doctors.

Dietary changes were made where at least one fruit and two portions of vegetables were served at every school lunch, and children were encouraged to eat the fruit first. Soya flour, brown bread, vegetable-stuffed rotis, sprouts, salad, millets and yogurt were incorporated into tasty ‘child-friendly’ lunch recipes. Vegetables were chopped or pureed so that children could not remove them from dishes.

“For students who brought their own lunches, we provided similar guidelines to their parents,” said Yeravdekar.

While the study highlighted the need for standardised fitness tests suitable for Indian children, it showed that introducing multiple changes in diet and physical activity at schools can indeed improve fitness levels.

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