How school-based interventions can help reduce the prevalence of NCDs in India
Two non-communicable diseases (NCDs)—heart disease and chronic obstructive pulmonary disease—were the leading causes of death in India in 2016. This is the classic good news/bad news situation: the good news is that infectious diseases in India are on the decline, but the bad news is that many deaths are now being caused by NCDs, at least some of which could have been prevented with better diet and behavior choices during childhood and adolescence.
Poor dietary habits during adolescence can lead to diabetes and heart disease later in life. This is an especially complex issue in India, a country that is facing both a widespread lack of proper nutrition and an explosion in obesity. In fact, with more than 14 million obese children and adolescents, India is second only to China for the largest number of obese children in the world.
To help identify the early dietary interventions that promise to have the greatest impact on Indian NCD rates, we evaluated 32 research studies—conducted between 2007 and 2017—on populations of Indian adolescents, teenagers, and early adults between the ages of 13 and 24. Grading the studies on strength of design, replicability, ease of implementation, and potential impact, we identified nine studies—all of them conducted in either public or private middle or high schools—that resulted in a marked improvement in their participants’ eating habits or other related indicators.
The Six Components of a Successful Dietary Intervention
We identified six components that each of these studies had in common:
1. Using a program design based on theory. Social cognitive theory, for example, posits that learning happens in a social context, meaning that an individual’s neighborhood, school, and past experiences all affect the ability to absorb information.
2. Teaching in groups. An approach that reaches a whole group can positively change social norms and encourage social support around healthy eating. In other words, if adolescents all learn the same lessons about nutrition, they are more likely to reinforce each other’s behavior.
3. Training teachers and staff. To effectively teach healthy eating habits, teachers and administrators need to understand why healthy eating is important and why they need to take ownership of the program. For example, educational posters hung in classrooms positively encourage teachers and students to work toward a common goal.
4. Employing multiple teaching techniques. The brains of adolescents change rapidly, and teenagers are easily distracted by social media, sports, and friends. Films, flash cards, quizzes, competitions, and computer-assisted tools can all keep students engaged in nutrition lessons.
5. Increasing the availability of healthy foods. Schools are more successful at encouraging healthy eating when they provide more nutritious food choices, such as fruits and vegetables. It’s also important for schools to serve fewer unhealthy foods in their cafeterias.
6. Engaging the help of parents. Schools that educate parents about the role of adolescent diet in the later development of NCDs see more positive changes in teen eating habits—especially if these parents serve more fruits and vegetables at home, or in their children’s packed lunches.
Adapting Dietary Lessons Learned from Other Countries
In addition to the insights we gleaned from studies conducted in India, we examined nutrition studies and guidelines from the United States and Europe for additional strategies that could be adapted for use by Indian schools and public health officials. Our findings included the following strategies:
- Recruiting peer leaders, for example, students who help friends choose fruits and vegetables at lunch rather than unhealthy foods
- Supplementing in-school nutrition education with trips to farms, or adding gardening to school activities
- Conducting early screening for obesity and poor diets, starting with children as young as six
- Improving the environments where adolescents eat and play
- Increasing access to clean water
- Harnessing the power of the internet and social media
- Amplifying healthy eating messages via social marketing and media campaigns
- Implementing national laws and policies (such as minimal nutritional requirements for school lunches)
- Enlisting the support of the private sector to improve food labels and reduce portion sizes
India needs effective science-based programs to combat adolescent risk factors like unhealthy diets and reduce deaths, and thus reduce the prevalence of NCDs later in life. We are confident that our research brief will inspire Indian educators, politicians, parents and students to tackle the problems of poor dietary choices and obesity in children and adolescents in the nation’s schools, the environment where interventions can make the most difference.