家校医联合干预改善肥胖儿童健康状态的 自身前后对照研究

A Self-Controlled Before-After Study on the Improvement of Health Status in Obese Children through Home-School-Medicine Joint Intervention

摘要: 肥胖已成为威胁儿童健康与社会发展的重大公共卫生问题，亟需系统性体重管理应对。本研究采用了自身前后对照设计，招募了来自重庆市涪陵区的14名肥胖小学生和16名肥胖初中生，旨在评估“家–校–医”融合闭环管理方案对肥胖儿童的减重效果。所有参与者接受了为期12个月的联合干预，参与了可行性和肥胖指标的测试和调查。数据采用单向方差分析和重复测量进行统计分析。共有29名肥胖儿童完成了研究。整个试验的保留率为96.7% (1名肥胖儿童因转学而退出)，健康教育课程参与率88.8% (8/9门)，体育课程参与率90.8% (109/120门)，且无不良事件报告。干预结束后初中组BMI (MD = −1.33, P = 0.011, Cohen’s d = −0.72)、体脂率(MD = −5.12, P = 0.001, Cohen’s d = −1.00)、腰围(MD = −2.34, P = 0.032, Cohen’s d = −0.58)均显著降低，TG (MD = −0.20, P = 0.010, Cohen’s d = −0.58)、HDL-C (MD = −0.42, P < 0.001, Cohen’s d = −0.58)显著改善。小学组干预后BMI (MD = 1.31, P = 0.011, Cohen’s d = 0.83)、体脂率(MD = 3.54, P = 0.016, Cohen’s d = 0.78)、腰围(MD = 5.54, P < 0.001, Cohen’s d = 1.57)反而升高。家校医联合干预可显著降低13~14岁初中生的BMI、体脂率及腰围，并改善脂质代谢(TG、HDL-C)，但对7~11岁小学生无积极作用。

Abstract: Childhood obesity constitutes a critical public health challenge, compromising both pediatric health and societal development, and thus necessitates systematic weight management. A self-controlled before-and-after study was conducted. A total of 14 obese primary school students and 16 obese junior high school students were recruited from Fuling District, Chongqing, to evaluate the weight loss effect of a “Home-School-Medicine” integrated closed-loop management program for obese children. All participants received a 12-month joint intervention and participated in feasibility assessments as well as tests and surveys on obesity-related indicators. Statistical analysis was performed using one-way ANOVA and repeated measures. A total of 29 participants completed the study, yielding a retention rate of 96.7% (one dropout due to school transfer). Participation rates were 88.8% (8/9 sessions) for health education and 90.8% (109/120 sessions) for physical activity. No adverse events were reported. After the intervention, the junior high school group exhibited significant decreases in anthropometric measures—BMI (MD = −1.33, P = 0.011, Cohen’s d = −0.72), body fat percentage (MD = −5.12, P = 0.001, Cohen’s d = −1.00), and waist circumference (MD = −2.34, P = 0.032, Cohen’s d = −0.58)—along with favorable changes in TG (MD = −0.20, P = 0.010, Cohen’s d = −0.58) and HDL-C (MD = −0.42, P < 0.001, Cohen’s d = −0.58). In the primary school group, BMI (MD = 1.31, P = 0.011, Cohen’s d = 0.83), body fat percentage (MD = 3.54, P = 0.016, Cohen’s d = 0.78), and waist circumference (MD = 5.54, P < 0.001, Cohen’s d = 1.57) paradoxically increased after the intervention. Overall, the family-school-hospital joint intervention significantly reduced BMI, body fat percentage, and waist circumference, and improved lipid profiles (TG and HDL-C) in adolescents aged 13~14 years, whereas it showed no positive effects in children aged 7~11 years.