Sports-health integration policy and childhood obesity: A difference-in-differences study

Background

Childhood obesity has emerged as a major public health challenge, necessitating global effort to turn the tide. Jiangsu Province initiated the Sports-Health Integration Policy (SHIP) and selected different municipalities as the pilot and control sites. SHIP combined hospital collaboration with a digital platform for continuous physical fitness and health monitoring and early warning, supported by coordinated school–family–community engagement to advance sports-health integration. This study evaluated the impact of SHIP implementation on obesity-related outcomes among primary school children.

Methods

We used individual-level longitudinal data from a total of 600 students from multiple schools in the pilot city and another 600 students from the counterpart city, respectively. The primary outcomes included the obesity prevalence rates and BMI z-score. Body fat percentage was measured using bioelectrical impedance analysis. Secondary outcomes included self-reported dietary intake, physical activity, and sedentary lifestyle. A quasi-experimental difference-in-differences framework was used to estimate changes in study outcomes in association with the SHIP implementation.

Results

Compared with their counterparts, children in the SHIP implementation areas experienced greater reductions in overweight/obesity prevalence, BMI z-score, and body fat percentage. SHIP implementation also led to favourable changes in obesity-related lifestyles, including lower consumption of sugar-sweetened beverages, higher levels of moderate-to-vigorous physical activity, and shorter daily screen time.

Conclusions

These findings indicated the field effectiveness of the SHIP implementation warrants continuous investment for scale-up. This hybrid digital-assisted policy plays a promising role in childhood obesity prevention. Further randomized trials with specific school-based programs are encouraged to consolidate the public health gain from SHIP implementation.

Key messages

• This study demonstrates that the Sports-Health Integration Policy reduces obesity prevalence and promotes healthier lifestyle behaviors among children.

• SHIP’s hybrid digital-assisted model represents a effective population-level approach, providing evidence for its broader scale-up.