An effective school-based intervention for breakfast promotion and overweight risk reduction

• The aim of this study was to evaluate the efficacy of a campaign promoting breakfast in primary school-children from the city of Parma, Italy, where in 2005, 22 per cent of peer school-children had reported to skip breakfast. The campaign started in all schools in the city of Parma from the fi rst school-day in 2008 and ended on the last school day in 2011.

  The campaign was part of a larger primary schools-targeted nutrition and sport educational program called GIOCAMPUS (the initial GIOstanding for “gioco”, which means “play” in Italian), supported by the Town Council, the School Inspectorate, the University of Parma, the Local Sport Clubs, and the Barilla Food Company based in Parma. The breakfast consumption campaign was promoted at different level by specificactions.

• School: the importance of consuming breakfast at home every day and its role in improving cognitive, learning and exercising skills were promoted weekly in the classrooms by teachers This process was further supported by specifi cally trained undergraduates of the Nutritional Sciences course of the University of Parma, called the “Taste teachers”. These students ran specifi c classroom breakfastcentred activities and games that enabled children to “learn by playing” that a correct continental breakfast should include a cup of milk, bread or cereal products, and fruit. At the beginning of every school year, nutritional and educational training courses for teachers were organized.
• Family: a booklet titled “Alarm obesity” was distributed to all families involved in campaign program. One chapter of this booklet was devoted to breakfast and to the relationship between skipping breakfast and the risk for obesity. A weekly plan of breakfast was added in the booklet. Four hour- practical cookery classes for parents were carried out in the Barilla Food Academy, where fi rst class Chefs demonstrated how it is possible and easy to prepare healthy breakfasts, snacks and other meals at home.
• Pediatricians: Paediatricians of the Parma city were informed about the three-year-campaign for breakfast promotion in schools and families and were asked to collaborate in spreading the information about the campaign to families. In this action, they were equipped with a kit, including both a poster to be displayed in their offi ces and a large number of leafl ets showing the same weekly breakfasts plan that were distributed to the parents. The Paediatricians were updated on campaign actions and progress by a monthly newsletter published also on the Giocampus website (www.giocampus.it).
• Summer Sport School (SSS): all children admitted to the two-week SSS spent eight hours each day engaged in various sports and physical activities under the supervision of professional instructors. The young campers ate snacks and lunch together always under supervision and following a menu suggested by pediatricians and dieticians.
• Media: the campaign benefi ted also from widespread promotion through local radio, TV and newspapers. Pediatricians, Nutritionists and Dieticians were regularly interviewed early in the morning on the nutritional, cognitive and exercise benefits from breakfast.

All the children enrolled into this study were requested on the 1st SSS day to answer a questionnaire on their breakfast habits. This questionnaire had previously been used in 2005. The questionnaire included questions with multiple answers and was completed before beginning any exercise with instructors. Children were asked to record whether, when, where, how and with whom they consumed breakfast, and what they did during breakfast, throughout the most recent consecutive one weekday before attending SSS.

Two groups of children attending SSS were interviewed on their breakfast habits through this multiple choice questionnaire. Group 1 counted only the children who underwent the intensive campaign (n. 341), and Group 2 a number of matched peers who did not attend any breakfast-promoting program (n. 291). Children who did not eat breakfast were found to be more numerous in Group 2 (17.5 per cent) than in Group 1 (8.0 per cent; p=0.0001).

In the Group 2 the percentage of overweight (18.4 per cent) was higher compared to Group 1 patients (11.7 per cent; p=0.022). No significant difference in obesity percentage (8.9 vs 5.0 per cent; p=0.071). Seventy fi ve per cent of children in Group I and the 25 per cent of children in Group 2 (p=0.031) had one or two parents who had reported to skip routinely breakfast. Children with one or both parents used to skip breakfast had a greater odds ratio of 3.04 and 3 respectively of skipping breakfast compared to the children with parents who had regularly breakfast (p=0.0002).

Compared to the children tested in 2005, children admitted to the Giocampus program showed:
– a significant decrease in breakfasting (22 vs 8 per cent; p=0.0001);
– a significant decrease in overweight (18.5 vs 11.7 per cent; p=0.003) but not in obesity (7.5 vs 5.0 per cent; p=0.138) status;
– a significant increase in consumption of cereals (p=0.0001) and fruit (p=0.0001).

In conclusion, an intensive breakfast-centred strategy seems to be effective in breakfast promotion and in overweight risk decrease.