La prévalence de l’obésité augmente, en particulier dans les familles en situation précaire. Cette étude avait pour but d’évaluer l’efficacité d’un dispositif de prévention de l’obésité chez des enfants scolarisés dans des zones urbaines sensibles (ZUS).

Il s’est agi d’un essai d’intervention avec comparaison avant/après d’une cohorte d’enfants scolarisés dans les écoles de maternelles et élémentaires, de 3 quartiers en ZUS de Grenoble. Ont été inclus dans l’étude les enfants scolarisés en 2008–2009 et 2009–2010. Le personnel du service de santé scolaire a mesuré et pesé les enfants lors de la visite médicale. Le médecin scolaire a proposé une prise en charge spécifique aux parents des enfants en excès pondéral et les enfants ont été revus 2ans plus tard. Le critère de jugement principal était l’évolution de l’indice de masse corporelle (IMC) et du Z-score à 2ans.

Parmi les 2434 enfants inclus dans le dispositif de dépistage, 1824 enfants ont été revus et évalués à 2ans. À l’inclusion, la prévalence de l’excès pondéral augmentait avec l’âge, passant de 6,4 % en petite section de maternelle à 21,9 % en cours élémentaire. Sur l’ensemble de la cohorte, la prévalence de l’excès pondéral a augmenté de 13,8 à 21,5 % en 2ans (p<0,001). Chez les 252 enfants dépistés en excès pondéral, l’IMC moyen a augmenté de 20kg/m² à 21,8kg/m² (p<0,001), de même que le Z-score moyen qui passait de 2,72 à 2,9 (p<0,001).

Cette étude a montré qu’une incitation à une prise en charge médicale de l’obésité n’avait pas d’effet sur l’évolution à court terme (2ans) de la corpulence des enfants.

Increasing prevalence of obesity particularly affects underprivileged families and children. This study aimed to estimate the efficiency of an obesity prevention program for school-aged children in deprived urban areas.

This was an intervention trial with a before-and-after comparison of a cohort of school-aged children in preschool and primary school in three deprived urban areas in Grenoble, France. All school-aged children in the first and third year of preschool and the third year of primary school during the 2008–2009 and 2009–2010 school years, whose parents agreed to participate in the study, were included. Children were seen again 2years later. The staff of the school health service measured and weighed the children during a medical check-up, thus determining their body mass index (BMI) and Z score. A school doctor suggested specific care to the parents of overweight children. A lifestyle questionnaire was completed. The primary outcome was changes in BMI and the Z score over 2years. The secondary outcome was changes in lifestyle and eating habits.

A total of 2434 children were included in the screening campaign. Of the 2434 children included in screening, 1824 children were reviewed and evaluated at 2years. At inclusion, overweight prevalence increased with age, from 6.4% in the first year of preschool to 21.9% in the third year of primary school. More than 60% of overweight children had a high social vulnerability score. Prevalence of overweight increased from 13.8% to 21.5% in 2years in the entire cohort (P<0.001). In the 252 overweight children, the mean BMI increased from 20kg/m² to 21.8kg/m² (P<0.001), as did the mean Z score, which increased from 2.72 to 2.9 (P<0.001). There was no significant interaction depending on whether the family physician was in private practice or employed by a health center. According to their eating habits, fewer of the overweight children had a snack in the morning and more had a school lunch. More than half of the children thought they had improved their eating habits. They played more sports (30% versus 49.5%).

This study failed to demonstrate that incentive for medical management of excess weight had an effect on the short-term (2years) evolution of the children's corpulence.