“Healthy Habits, Healthy Girls—Brazil”: an obesity prevention program with added focus on eating disorders
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To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized controlled trial for girls targeting shared risk factors for obesity and disordered eating.
Total of 253 girls, mean of 15.6 (0.05) years from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. “Healthy Habits, Healthy Girls—Brazil (H3G-Brazil)”, originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6 months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention prior to follow-up assessment. A conservative significance level was set at p < 0.01.
Beneficial effects were detected for PA social support (F = 6.005, p = 0.01), and healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731, p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy weight control behaviors (OR = 1.92, 95% CI 1.15–3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects were detected.
H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an intervention among low-income girls in Brazil.
Level I: cluster randomized controlled trial
KeywordsAdolescence Girls Eating disorders Obesity Prevention Social cognitive theory
Body mass index
Healthy Habits, Healthy Girls—Brazil
Low- and middle-income countries
Social cognitive theory
The authors thank the participant schools and adolescent girls for the value contribution. We also thank FAPESP twice: for AL post-doctoral training in Brazil (process no. 2015/20852-7) and for the grant to conduct the research internship at Baylor College of Medicine, Children’s Nutrition Research Center, Houston, Texas to AL (process no. 2016/21144-9).
All authors truly contributed to the development of this study. AL: participated in study concept and design, acquisition of data, analysis and interpretation of data, drafting the manuscript, critical revision of the manuscript for intellectual content and statistical analysis. SP: senior research of this project, participated in study concept and design, acquisition of data, drafting the manuscript and critical revision of the manuscript for important intellectual content. DT: participated in drafting the manuscript, critical revision of the manuscript for intellectual content and statistical analysis. TN: participated in drafting the manuscript, critical revision of the manuscript for intellectual content and statistical analysis. TB: participated in analysis and interpretation of data, drafting the manuscript, critical revision of the manuscript for intellectual content and statistical analysis.
No funding was received.
Compliance with ethical standards
Conflict of interest
The authors do not have any particular conflict of interest. Author ACBL received a post-doctoral scholarship from the São Paulo Research Foundation (Fundação de Amparo à Pesquisa—FAPESP).
This research received ethical approval from the School of Public Health, University of São Paulo (FSP-USP) ethics committee under the protocol number 01658112.6.0000.5421.
The parents/caregivers of the girls and the school principals provided written informed consent, as well as the girls provided assent forms for participation prior to data collection.
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