The effect of a multi-component school-based social network intervention on children's body mass index: a four-arm intervention study.

Schools are considered an important setting for stimulating healthy weight. The current study is unique in examining effects of a multi-component school-based social network intervention on children's body mass index -scores (BMI). Four schools were randomly allocated to one of four conditions: a social network intervention using influence agents focusing on water consumption, physical activity, a combination of the two, or a passive control condition. Participants included a total of 201 6- to-11-year-old children (53.7% girls; = 8.51, = 0.93). At baseline, 149 (76.0%) participants had a healthy weight, 29 (14.8%) had overweight and 18 (9.2%) had obesity. Linear mixed effect models indicated that a multi-component school-based social network intervention targeting both water consumption and physical activity was most effective in decreasing children's BMI. This study suggests that schools can contribute to the intervention of childhood obesity-even without involving the parents-by targeting children's water consumption and physical activity through influential peers, but more research is needed to identify mechanisms of change.