Generation Healthy Kids: A cluster-RCT using systems thinking to promote child health and wellbeing

Abstract Background and Aim Results from intervention studies to prevent childhood obesity have generally been disappointing, with most interventions showing none or clinically irrelevant effects. In this presentation, we will 1) provide an overview of existing evidence for effective obesity preventive interventions, 2) discuss the potential of systems thinking and multi-setting, community- and school-based approaches to prevent childhood obesity, and 3) present design, methods, and preliminary experiences from the Generation Health Kids study. Methods Generation Healthy Kids is a multi-setting, multi-component intervention to promote healthy weight development and wellbeing in Danish children aged 6-11 years. The intervention targets families, schools, after-school clubs, and local communities, and focuses on diet, physical activity, screen media use and sleep. The intervention incorporates certain fixed elements, including a school lunch program and three weekly physical activity sessions at school. Building on systems thinking, the intervention also encompasses elements co-created with local community stakeholders, e.g. municipalities, leisure associations and supermarkets. The intervention is evaluated in a cluster-randomized trial for two school years (2023/24 and 2024/25) in 23 Danish schools (12 intervention, 11 control) with 1,500 participating children in grades 1-3. Effectiveness data on body composition, anthropometry, wellbeing, and other health outcomes are collected at baseline, interim (end of school year 1) and end-of-study (end of school year 2). Results The presentation will discuss potentials and challenges of combining systems thinking and co-creative approaches with stringent cluster-randomized trial designs in child health promotion and obesity prevention, based on concrete examples from our implementation of Generation Healthy Kids.