Partecipazione all'ECOG a Dublino

KALÈDO, A NEW EDUCATIONAL BOARD-GAME REDUCE OVERWEIGHT AND OBESITY IN PRIMARY SCHOOL CHILDREN
Emanuela Viggiano1, Salvatore Amaro1, Andrea Viggiano2, Alessandro Viggiano1, Marcellino Monda1,
Anna Di Costanzo3, Claudia Vicidomini2, Eleonora Andreozzi4 and Bruno De Luca1
1 Second University of Naples – Department of Experimental Medicine; 2 University Parthenope – Faculty of Motor Science; 3 ASL NA1 – Paediatrician; 4 Secondary School - ITCG “Archimede” – Teacher

INTRODUCTION
Prevention of obesity and overweight is an important target for health promotion. Early prevention requires an intervention during childhood and adolescence (1, 2). At these ages, game can be an appropriate means to teach nutrition knowledge and to influence dietary behaviour (3).
A pilot study demonstrated that the board-game Kalèdo increased nutrition knowledges and modified the dietary behaviour in child of middle school (4). The present study was aimed to confirm the efficacy of Kalèdo on changes in dietary behaviour and physical activity and to reduce overweight and obesity in primary school (age 9±1).
METHODS
KALÈDO

Kalèdo is a board-game that can be played by up to four people at a time and is composed of:
1) One play board with 59 boxes marked on it [Fig. 1]. 2) 100 cards (80 cards related to nutrition and 20 cards related to activity) [Fig. 2A, 2B] 3) Four “kaledoscopes” [Fig. 3],

by which the player can calculate the balance between the energy intake from the food intake and the energy expenditure due to basal metabolic rate (BMR) and physical activity. A typical play session requires 2 to 4 players and lasts about 15 to 30 min.

QUESTIONNAIRE
The WHO HBSC physical activity questionnaire on physical activity and an alimentary diary including junk food (e.g. chips and soft drink) and healthy food (e.g. fruit, vegetables) were completed by participants; snack consumption at school was also recorded for one week. The WHO HBSC physical activity questionnaire asked students to report the frequency and total amount of time spent exercising vigorously outside school hours [5].

PROTOCOL
A simple two group design (treatment and control) with pre- and post assessment was employed. A total of 66 classrooms (1,007 students) were recruited to participate in the experiment. Subjects from the treatment group participated every week in one play session.

ANTHROPOMETRIC INDEXES
Anthropometric measures were carried out at the beginning of the study and after 8 months for all subjects. Anthropometric variables (height, weight, WC) were measured according to the Anthropometric Standardization Reference Manual (Lohman et al., 1998). Body mass index (BMI) was calculated as weight (kg)/height (m2). Normal, overweight and obese subjects were defined comparing their BMI to the cut-off values reported by Coole et al [6].
 

STATISTICAL ANALYSIS
Mixed ANCOVA was used to test for differences between treatment and control groups (fixed effect) in BMI, physical activity and diet at post-assessment.

RESULTS AND CONCLUSION
BMI was significant decreased in the overweight/obese children at 8 months in the treated group compared to the control group [Fig. 4]. No significant difference was seen in children with a ‘normal’ BMI. Frequency and duration of physical activity were increased in the treated group compared to the control group [Fig. 5]. There was, also, an increase in fruit, vegetables and fruit-juice intake in the treated group compared to the control group [Fig. 6]. The results demonstrated that Kalèdo can effectively decrease the risk of developing obesity in children, in fact the BMI in overweight/obese child decreased after playing with Kaledo. Kalèdo can modify the frequency and the duration of physical activity and the dietary
behaviour. 

REFERENCES
[1] Montessori M (1909). Il metodo della pedagogia scientifica applicato all’educazione infantile nelle case dei bambini. Città di Castello (ed), Rome
[2] Winnicot D (1990). Gioco e realtà. Armando ed., Rome
[3] Bartfay WJ, Bartfay E (1994) Promoting health in schools through a board game. West J Nurs Res 16:438–446
[4] Corbett RW, Lee BT (1992). Nutriquest: a fun way to reinforce nutrition knowledge. Nurse Educ 17:33–35
[5] Amaro S, Viggiano A, Di Costanzo A, Madeo I, Viggiano A, Baccari ME, Marchitelli E, Raia M, Viggiano E, Deepak S, Monda M, De Luca B (2206). Kalèdo, a new
educational board-game, gives nutritional rudiments and encourages healthy eating in children: a pilot cluster randomized trial. Eur J Pediatr.165(9):630-5. Epub 2006 May 30.
[6] Cole TJ, Flegal KM, Nicholls D, Jackson AA (2007). Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 28;335(7612):194.