Improving healthy energy balance- and obesity-related behaviours among preschoolers in Malaysia: feasibility of adapting the ToyBox-Study

这项研究解决了解决儿童肥胖症上升的迫切需要;马来西亚在越来越多的幼儿超重或肥胖方面比其他东南亚国家遭受更多的痛苦。肥胖有许多不良后果，包括发展非传染性疾病，如2型糖尿病、心血管疾病和某些癌症。如果肥胖水平继续增长，这些疾病将在更年轻的年龄发生，并在人口中增加流行率。此外，肥胖会损害身体和精神发育和功能，从而损害个人福祉和国家福利和经济。世界卫生组织最近的一份报告认识到，结束儿童肥胖症将需要多种和多方面的干预措施，包括改变政策，教育和环境，以实现与肥胖风险相关的行为的持续变化。由于这些行为中的许多很快成为习惯，主要建议包括针对幼儿期，鼓励健康饮食，体育活动，减少久坐行为和减少含糖饮料的摄入。然而，要成功地做到这一点，不仅需要教育，还需要消除这些行为的环境障碍，以及幼儿家庭的参与。ToyBox研究方案（www.toybox-study.eu）是一项纳入这些方面的干预措施，已经在六个欧洲国家的4-6岁幼儿园儿童中试用。干预措施旨在幼儿园实施，由幼儿园教师通过开展有针对性的活动和改变幼儿园环境来鼓励儿童的健康行为。这允许动手学习灌输健康的习惯，如饮用水作为主要液体，而不是甜饮料，更健康的零食，享受更多的体育活动，避免长时间久坐不动的行为。与学校相比，幼儿园环境也是一种相对廉价和干扰较小的干预环境。ToyBox-Study计划有一套完整的材料来指导幼儿园教师和儿童的主要照顾者实现这些更健康的行为。然而，人们认识到，一些材料的适应，以及翻译，可能是必要的马来西亚社会文化背景。因此，本研究的主要目的是进行可行性研究的适应和应用的ToyBox干预马来西亚幼儿园，在马来西亚半岛和砂拉越的网站。干预措施将在幼儿园一年内持续24周。在基线和干预后将进行与原始研究相似的测量，包括儿童的身高和体重，以便与ToyBox研究中发表的证据进行比较。这些将评估干预措施是否改变了与健康有关的行为，以及利益攸关方、教师和儿童家庭对干预措施的接受程度。此外，6个月后将进行一系列后续测量，以确定任何行为变化的可持续性。将与未参加干预但在同一时期以相同方式测量其儿童的幼儿园进行比较。这些幼儿园将从KEMAS的幼儿园库中招募，以便更多的贫困儿童和家庭能够受益。 这项研究将由经验丰富的大学工作人员进行，他们在肥胖，营养，行为和教育方面具有专业知识：每个地点都将有一个单独的团队。当地团队将得到英国专家的大力支持，其中两名专家曾参与最初的ToyBox研究计划。将在每个阶段提供指导和培训。

This research addresses the urgent need to tackle the rise of childhood obesity; Malaysia is suffering more than other Southeast Asian countries in terms of increasing numbers of young children becoming overweight or obese. There are many adverse consequences of obesity, including development of non-communicable diseases such as Type-2 diabetes, cardiovascular disease and some cancers. These diseases will occur at younger ages and increase in prevalence in the population if obesity levels continue to grow. In addition, obesity can harm both physical and mental development and function, thus harming both individual wellbeing and national welfare and economy. A recent report from the World Health Organisation recognises that ending childhood obesity will require multiple and multifaceted interventions, involving changes to policy, education and the environment, in order to deliver sustained changes in behaviours related to obesity risk. Since many of these behaviours rapidly become habitual, key recommendations include targeting early childhood to encourage healthy eating, physical activity, less sedentary behaviour and reduced intake of sugar-sweetened beverages. However, to do this successfully requires not just education, but also removal of environmental barriers to these behaviours, and engagement of the young children's families. The ToyBox-Study programme (www.toybox-study.eu) is one intervention that incorporates these facets and has already been trialled in 4-6 year-old kindergarten children across six European countries. The intervention is designed to be carried out in kindergartens, involving the kindergarten teachers encouraging healthy behaviours in the children, by educating through specially focussed activities, and by changing the kindergarten environments. This permits hands-on learning to instil healthy habits, such as drinking water as the main fluid in place of sweetened drinks, healthier snacking, enjoying more physical activity, and avoiding prolonged periods of sedentary behaviour. The kindergarten setting is also a relatively inexpensive and less disruptive, than a school setting for such an intervention. The ToyBox-Study programme has a complete set of materials to guide kindergarten teachers, and the primary caregivers of the children, in achieving these healthier behaviours. However, it is recognised that some adaptation of the materials, as well as translation, may be necessary for the Malaysian sociocultural context. Thus, the primary aim of this research is to conduct a feasibility study of the adaptation and application of the ToyBox intervention in Malaysian kindergartens, in sites in both Peninsular Malaysia, and in Sarawak. The intervention will run for 24 weeks across a kindergarten year. Similar measurements will be taken at baseline and post-intervention as in the original study, including height and weight of the children, so that comparisons can be made with published evidence from the ToyBox-Study. These will evaluate whether the intervention has altered the health-related behaviours, as well as the acceptability of the intervention to stakeholders, teachers and families of the children. In addition, a follow-up set of measurements will be made 6 months later, to determine how sustainable any behavioural changes have been. Comparison will be made to kindergartens not enrolled in the intervention but whose children will be measured in the same way over the same period. The kindergartens will be recruited from the KEMAS pool of kindergartens, so that a greater number of underprivileged children and families can benefit. The research will be conducted by experienced University staff with expertise in obesity, nutrition, behaviour and education: a separate team will be based at each site. The local teams will be strongly supported by UK experts, two of whom worked on the original ToyBox-Study programme. Guidance and training will be provided at every stage.