# Schoolchildren as health promoters: a community strategy for healthy eating and physical activity to reduce nutritional risk

## TL;DR

This study shows that training schoolchildren as health promoters can effectively reduce obesity risk by improving nutrition and physical activity in their communities.

## Contribution

The novel approach uses schoolchildren as health promoters to drive community-based health improvements in nutrition and physical activity.

## Key findings

- Children in the HPC program had significantly lower body fat and improved cholesterol levels compared to the reference group.
- The Healthy Eating Index improved with the child-promoter model, indicating better dietary habits.
- Key barriers to health improvement included unhealthy food supply and lack of physical activity promotion.

## Abstract

The obesity epidemic in Mexico demands sustainable solutions based on participatory strategies that actively involve the community. Community-Based Participatory Research (CBPR) is a key strategy, as it not only considers the community as a source of information but also empowers it to propose solutions tailored to local realities.

This study aimed to develop and evaluate a model of schoolchildren’s health promoters (HPC) as a community communication strategy to foster better nutrition, food environment, and physical activity practices, thereby reducing nutritional risk in schoolchildren.

Health promotion activities were implemented in parallel: in program schools (through child promoters or HPC) and in reference schools (using conventional methods, such as talks and brochures). Both quantitative data (anthropometrics, body composition, diet, and physical activity) and qualitative data (focus groups and interviews with parents, teachers, and principals) were collected in 36 public elementary schools across Hermosillo and Mexicali (Northwest Mexico), as well as Tuxtla Gutiérrez (Southeast Mexico), reaching a total population of approximately 10,800 children.

The results showed that body fat percentage was significantly lower in children after the HPC program compared to the reference group (33.9 ± 10.4 vs. 35.7 ± 9.7, p = 0.001); also, total cholesterol (18.93 ± 41.51 vs. 1.01 ± 41.45; p = 0.019), HDL cholesterol (14.63 ± 11.54 vs. 6.56 ± 15.56; p = 0.005), and the Healthy Eating Index (HEI) (3.5 ± 18.1 vs. − 3.4 ± 15.7; p = 0.026), improved with the participatory model. The main environmental factors identified as barriers were the unhealthy food supply at school and home, the lack of promotion for regular physical activity, and family economic limitations.

Despite the challenges children face in exercising their agency in traditional interactions, this study suggests that a child-promoter model is more effective than conventional nutrition education and that involving the school community in activities to improve their health yields promising results in reducing nutritional risk.