A Comprehensive School Health Program to Reduce Disparities and Risk for Type 2 Diabetes in Overweight At-Risk Youth

Abstract

With the significant increase in the number of racial/ethnic minority youth with obesity and type 2 diabetes mellitus (T2DM), effective approaches are urgently needed. Although previous school-based studies have demonstrated that programs combining environmental, behavioral and educational components can be successful in preventing cardiovascular disease in youth such studies have not focused on youth at higher risk for T2DM-inner city, racial/ ethnic minority youth. Engaging in regular physical activity is widely accepted as an effective preventative measure for a variety of obesity-related chronic diseases including diabetes and metabolic syndrome. Disparities exist where racial/ethnic minority and low-income youth do not meet these physical activity recommendations. Schools, through the provision of culturally and developmentally appropriate healthy lifestyle programs, have the power to decrease body mass index (BMI) and increase physical activity, especially for racial/ethnic, inner-city at youth at risk for T2DM. The present clustered, randomized controlled trial study utilized a community-based participatory research approach to evaluate the impact of a family-centered, culturally sensitive, comprehensive school health program, called Kids N Fitness © , on BMI z-scores and physical activity behaviors of the youth participant from baseline to the 12-month followup among a sample of Mexican-American, inner-city elementary school youth (N = 97) in Los Angeles County at risk for T2DM. Results: Youth who participated in the KNF © program had significant decreases in BMI (p = 0.05), BMI body mass index z-scores (p = 0.03), vigorous daily physical activity (p = 0.01) and PE class attendance (p = 0.02) from baseline to the 12 month follow-up. Conclusions: These results suggest that a culturally appropriate, comprehensive school health program may have promise for decreasing BMI and BMI z-scores and increasing activity in this high risk sample. Clinicians and teachers can incorporate the approaches used in this study to reduce the risk of T2DM in youth at risk. Comprehensive school health programs and prevention of T2DMGiven the rapid rise in obesity among youth, researchers have focused on developing comprehensive programs with the goal of reducing or preventing increases in BMI. A Cochrane review of 64 randomized clinical interventions designed to treat obesity in youth concluded that behavior lifestyle interventions had a significant effect on reducing BMI in youth up to 12 months post-intervention, noting that the most effective interventions combined dietary, physical activity and behavioral components [12]. Schools serve as an excellent venue to provide students with the opportunity for daily physical activity and to teach the importance of regular physical activity and a healthy diet in order to build skills that support active lifestyles [13][14][15] and decrease their risk for T2DM. Schools have access to school nurses who can provide screening, counseling and continuum of care [13][14][15]. In co...

Training At-Risk Youth to Become Diabetes Self-management Coaches for Family Members

“…Evidence strongly suggests that school-based health programs hold promise to improve health of at-risk adolescents. Such programs—such as those conducted by the Healthy Study Group, 27 the Kids N Fitness Program group, 28 or the prevention program tested by Grey et al 29 —demonstrate that combining health education and communication in a community and family context holds potential to reduce risk factors for type 2 diabetes among ethnic-minority youth of low socioeconomic status.…”

School Health Program: Impacting Physical Activity Behaviors Among Disadvantaged Students

“…There were significant increases from baseline to 4‐month assessment for vigorous physical activity in the intervention group and the effect was sustained at 12 months for vigorous physical activity. As compared to English speakers, Spanish‐speaking students had significant increases from baseline to 12 months in vigorous physical activity …”

“…Another factor for an effective program may be parent involvement in the program. Four of the programs involved family members to reinforce lessons taught . In these programs, physical activity behaviors for participants were increased.…”

“…Other ideas for improving knowledge about program impact including implemented for longer durations and with more frequent sessions for future programs . Researchers and program leaders also should include behavior modification components, such as goal setting and self‐motivation, to positively impact participants' physical activity behaviors …”