An intervention to promote Healthy Eating and Physical Activity in Lebanese School children: Health-E-PALS a pilot cluster randomised controlled trial

Aim and objectives: The purpose of this study was to develop, implement and evaluate the effectiveness of a multicomponent school-based intervention that focused on promoting healthy eating and physical activity with school children (aged 9 to 11 years) in Lebanon, in order to prevent childhood obesity. Methods: A school-based intervention adapted to the culture of Lebanese and Arab populations and based on the constructs of the Social Cognitive Theory was developed. The intervention consisted of three components: classroom curriculum, food service, family involvement. Eight schools were selected from two different communities (high and low socioeconomic status) in Beirut and were randomly assigned (by a toss of a coin) to either the intervention or control group. Students aged nine to eleven years in intervention schools were exposed to the intervention components for three months. Students in control schools received their usual school curriculum. Anthropometric measurements, questionnaires on determinants of behavioural change, eating and physical activity habits were completed by the students in both groups at baseline and post intervention. Focus group interviews were conducted with students, teachers and parents in intervention schools at the end of the study. Results: Changes were observed based on self-report measures. Daily breakfast intake increased significantly in the intervention group compared with the control group (3.5 times more p<0.001). Students in the intervention group reported consuming significantly less chips and sweetened drinks at post-test compared with controls (86% & 88% less respectively p<0.001). There was no difference in physical activity and screen time habits and no changes in BMI between groups at post intervention. Knowledge and self-efficacy scores increased for the intervention (+2.8 & 1.7 points respectively p<0.001) but not for the control group. Interview data from focus groups showed that the programme was generally well accepted; students benefited in a pleasurable way and made attempts to change their eating and physical activity habits. Limitations for better outcomes include the length of the programme and the school environment. Conclusion: “Health-E-PALS” (Healthy Eating and Physical Activity in Lebanese School children) is a promising innovative, theory-based, culturally sensitive intervention to promote Healthy Eating and Physical Activity in Lebanese school children with a regional perspective

Ajyal Salima a novel public–private partnership model for childhood obesity prevention in the Arab countries

The prevalence of childhood overweight and obesity among children is on the rise around the world. Meanwhile, comprehensive multi-sectorial approaches have been found to be effective in improving nutritional status among children. Ajyal Salima is a public–private partnership (PPP) school-based nutrition and physical activity intervention program implemented in six Arab countries. Its objective is to promote healthy eating and physical activity habits among 9–11-year-old students. The stakeholders, involved with the implementation of the program, comprised (1) local authorities, ministries of Education and Health, and non-governmental organizations (NGOs) as public partners, (2) The American University of Beirut (AUB) as the academic/regional scientific partner, and (3) Nestlé as the private partner. The Ajyal Salima program encompasses four coordinated educational components: classroom sessions, family involvement, food service intervention, and training of trainers. The program's educational material has been culturally adapted to each country's needs, as well as pilot tested. This paper describes the strategies used to build the PPP framework of Ajyal Salima, and the role of each stakeholder. The Ajyal Salima program is an example of a promising and sustainable comprehensive PPP program to address childhood obesity, that can be exported to other countries in the region and globally

A randomised controlled school-based nutritional intervention in five Middle Eastern countries: Ajyal Salima improved students’ dietary and physical activity habits

Abstract Objective: The purpose of this study was to measure the impact of the Ajyal Salima school intervention on nutrition and physical activity outcomes in children aged 9–11 years. Design: The study was a 1-year cluster-randomised controlled trial. Ajyal Salima used a multi-component approach including classroom activities, family programme and food service adaptation. Outcomes included daily intake of breakfast, frequency of healthy and unhealthy food consumption, frequency of physical activity, knowledge score and self-efficacy score. Intervention and control groups were compared for all main outcomes and a post-intervention qualitative evaluation assessed strengths and limitations of the intervention components. Setting: Schools in five countries – Lebanon, Jordan, Palestine, Saudi Arabia and Bahrain. Participants: Schools were selected by Ministries of Health and Education within their jurisdictions. Forty-five intervention schools (6052 students) and forty-six control schools (6200 students) were included in the analysis. Results: The intervention group had a significantly higher odds of consuming breakfast daily (OR 95 % CI = 1·60, 1·35, 1·90), consuming healthy foods (OR 95 % CI = 1·60, 1·39, 1·84) and a decreased odds of consuming unhealthy foods and sweetened beverages (OR, 95 % CI = 0·70, 0·60, 0·81). Additionally, school children in the intervention group, as compared with the control group, were 47 % more likely to exercise outside school hours (OR 95 % CI = 1·47, 1·23, 1·76). Lastly, children in the intervention group had a significantly improved nutritional knowledge score and improved self-efficacy by 1·3 score unit and 1·1 score unit, respectively. Conclusions: The Ajyal Salima intervention led to significant improvements in dietary and physical activity habits among school children and increased nutritional knowledge scores

Assessment of Dietary and Lifestyle Responses After COVID-19 Vaccine Availability in Selected Arab Countries

The COVID-19 pandemic has been consistently associated with unhealthy lifestyle behaviors and dietary practices. This study aimed to assess the dietary and lifestyle behaviors of adults after COVID-19 vaccine availability and their attitude toward the vaccine in selected Arab countries. A cross-sectional survey-based study was conducted between October 2021 and December 2021 using Google Forms (n = 2259). A multi-component questionnaire was used to collect socio-demographic characteristics, attitudes toward the COVID-19 vaccine, and behavioral, dietary, and lifestyle responses after easing the restriction. Participants were given a score based on the sum of positive dietary and lifestyle changes. The generalized linear models were used to identify the association between positive dietary and lifestyle changes score and sociodemographic characteristics. Weight gain during the pandemic was reported by 39.5% of the participants, 36.1% reported ever getting infected with the COVID-19 virus, and 85% received at least one dose of the vaccine. The key adverse reactions of the COVID-19 vaccine were fatigue, headache, and joint pain, and the main reason for vaccination was protection against infection. Most participants were concerned about the vaccine side effects (45.8%) and inadequate testing (50.7%). After easing of restriction, 54.3% of the participants reduced the frequency of disinfecting objects, and 58.3% joined social events. Most dietary and lifestyle behaviors remained unchanged after vaccine availability but there was an increase in the time spent behind the screen for work (50.1%) and entertainment (42.9%). The results of the multivariate regression analyses revealed that older participants (p = 0.001), those with higher education (p = 0.010), and those working from home (p = 0.040) were more likely to have higher positive dietary and lifestyle changes scores. Although most participants were concerned about vaccine safety, low vaccine hesitancy rates were observed among the study sample. The availability of the COVID-19 vaccines resulted in loosening some of the safety social measures among Arab adults but the negative impact of the pandemic on dietary and lifestyle behaviors remained unaltered

Assessment of Eating Habits and Lifestyle during Coronavirus Pandemic in the MENA region: A Cross-Sectional Study

© The Authors 2020. The coronavirus disease (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviors among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from 18 countries participated in the current study. During the pandemic, over 30% reported weight gain, 6.2% consumed five or more meals per day compared to 2.2% before the pandemic (p\u3c0.001), and 48.8% did not consume fruits on daily basis. Moreover, 39.1% did not engage in physical activity, over 35% spent more than five hours per day on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (p \u3c 0.001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability, and tension either all the time or a large part of the time during the pandemic (p \u3c 0.001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63% had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity, and psychological problems among adults in the MENA region

First Physical Activity Report Card for Children and Youth in Lebanon

Evidence on physical activity (PA) indicators for children and youth at a national level is necessary to improve multilevel support for PA behaviors. Lebanon's first Physical Activity Report Card for children and youth (2018) aimed to fill this gap. : In line with the recommended methods of "Global Matrix 3.0," nationally representative data were retrieved from peer-reviewed manuscripts, national surveys, and government reports. In addition to adopting the 10 indicators of "Global Matrix 3.0," publications that discussed weight status were also retained. A grade was assigned for each indicator using a standard rubric: A = 80% to 100%, B = 60% to 79%, C = 40% to 59%, D = 20% to 39%, F = <20%, and INC = incomplete data. : Four indicators (active play, family and peers, community and environment, and physical fitness) received an "INC." Three indicators (overall PA, active transportation, and school) received a "D." Sedentary behaviors received a "C-." Weight status received a "C." Government received a "C+." Organized sport received an "F." : PA participation among Lebanese children and youth is low. Stakeholders should aim to improve low PA indicators grades. Gaps in the literature also need to be filled to inform on the status of all indicators

Results from Lebanon's 2018 Report Card on Physical Activity for Children and Youth

The prevalence of childhood obesity in Lebanon nearly doubled between 1997 and 2009.1 This shift in population health is extremely alarming, given that obesity is associated with a host of chronic diseases (eg, cardiovascular diseases, diabetes mellitus, cancer)1 representing the primary causes of death and disease burden in 2012.2 Low physical activity (PA) levels and engagement in greater sedentary activities have been used to explain such trends.1 However, little is known about PA indicators among Lebanese children and youth. This led to the development of Lebanon’s first Physical Activity Report Card for Children and Youth (Figure 1)

Impact of COVID-19 on mental health and quality of life: Is there any effect? A cross-sectional study of the MENA region.

The COVID-19 pandemic is a major health crisis that has changed the life of millions globally. The purpose of this study was to assess the effect of the pandemic on mental health and quality of life among the general population in the Middle East and North Africa (MENA) region. A total of 6142 adults from eighteen countries within the MENA region completed an online questionnaire between May and June 2020. Psychological impact was assessed using the Impact of Event Scale-Revised (IES-R) and the social and family support impact was assessed with questions from the Perceived Support Scale (PSS). The IES-R mean score was 29.3 (SD = 14.8), corresponding to mild stressful impact with 30.9% reporting severe psychological impact. Most participants (45%-62%) felt horrified, apprehensive, or helpless due to COVID-19. Furthermore, over 40% reported increased stress from work and financial matters. Higher IES-R scores were found among females, participants aged 26-35 years, those with lower educational level, and participants residing in the North Africa region (p<0.005). About 42% reported receiving increased support from family members, 40.5% were paying more attention to their mental health, and over 40% reported spending more time resting since the pandemic started. The COVID-19 pandemic was associated with mild psychological impact while it also encouraged some positive impact on family support and mental health awareness among adults in the MENA region. Clinical interventions targeted towards vulnerable groups such as females and younger adults are needed