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上升的迫切需要；越来越多的儿童超重或肥胖，马来西亚比其他东南亚国家更严重。肥胖有许多不良后果，包括2型糖尿病、心血管疾病和某些癌症等非传染性疾病的发展。如果肥胖水平继续增长，这些疾病将在更年轻的人群中发生，并在人群中流行。此外，肥胖会损害身体和精神的发展和功能，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承认，消除儿童肥胖需要多方面的干预措施，包括改变政策、教育和环境，以便持续改变与肥胖风险相关的行为。由于许多这些行为很快就会成为习惯，因此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-Study项目（www.toybox-study.eu）是一种结合了这些方面的干预措施，已经在6个欧洲国家的4-6岁的幼儿园儿童中进行了试验。该干预措施将在幼儿园实施，包括幼儿园教师鼓励儿童的健康行为，通过特别集中的活动进行教育，并改变幼儿园的环境。这样可以通过动手学习来灌输健康的习惯，比如以水作为主要的液体来代替含糖饮料，吃更健康的零食，享受更多的体育活动，避免长时间久坐不动。对于这种干预，幼儿园的环境也相对便宜，而且比学校的环境更具破坏性。“玩具箱-学习”方案有一套完整的材料，用于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，对材料进行一些改编，以及翻译，可能是马来西亚社会文化背景所必需的。因此，本研究的主要目的是对马来西亚半岛和沙捞越州幼儿园的ToyBox干预措施的适应和应用进行可行性研究。干预将在幼儿园的一年中进行24周。与最初的研究一样，在基线和干预后将进行类似的测量，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。这些评估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个月后将进行一套后续测量，以确定任何行为变化的可持续性。将与未参与干预的幼儿园进行比较，但这些幼儿园的孩子将在同一时期以相同的方式进行测量。这些幼儿园将从KEMAS的幼儿园池中招募，以便更多的贫困儿童和家庭受益。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，其中两位曾参与最初的ToyBox-Study项目。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.