Long-Term Effectiveness of a School- and Community-Based Intervention for the Prevention of Childhood Obesity in High-Risk Families Across Europe: The Feel4Diabetes Study

Abstract

Introduction: Obesity disproportionately affects children from socioeconomically disadvantaged backgrounds. This study assessed the effectiveness of the Feel4Diabetes intervention on weight outcomes among children from low socioeconomic settings. Methods: Feel4Diabetes was a randomised pragmatic trial implemented in real-world school and community settings across Europe. Using a two-stage screening procedure, families were recruited and categorised as either ‘all families’ or ‘high-risk families’. The intervention included a 2-year school-based health promotion for all families and additional counselling for high-risk families. Weight improvement was defined as a reduction of ≥ 0.2 BMI z-score units among children with overweight/obesity. Multiple logistic regressions identified predictors of improvement. Results: Data from 2710 children from high-risk families and 7625 children from all families were analysed. After 2 years, a higher proportion of children from high-risk families in the intervention group reduced their BMI z-score compared to the control group (p = 0.002). Children from non–high-risk families showed only a marginal improvement. Multivariate analyses identified predictors of improvement: randomisation in the intervention group (OR = 1.46; 95% CI: 1.14–1.87), baseline obesity (OR = 1.55; 95% CI: 1.16–2.08), residence in LMICs (OR = 2.33; 95% CI: 1.65–3.30) or HICs facing economic crisis (OR = 2.12; 95% CI: 1.54–2.91), and reported financial difficulties (OR = 1.36; 95% CI: 1.06–1.74). Interestingly, maternal obesity was positively associated with BMI z-score improvement (OR = 1.31; 95% CI: 1.03–1.68), while higher maternal education was inversely related (OR = 0.64; 95% CI: 0.41–0.99). Conclusion: These findings underscore the importance of equity-oriented, long-term interventions addressing both behavioural and structural determinants of obesity.