A holistic school-based intervention for improving health-related knowledge, body composition, and fitness in elementary school students: an evaluation of the HealthMPowers program

Abstract

BackgroundOver the past 30 years, obesity in the United States has increased twofold in children and threefold in adolescents. In Georgia, nearly 17% of children aged 10 – 17 are obese. In response to the high prevalence of child obesity in Georgia and the potential deleterious consequences that this can have, HealthMPowers was founded in 1999 with the goal of preventing childhood obesity by improving health-enhancing behaviors in elementary schools, utilizing a holistic three-year program. This study measures the effectiveness of the HealthMPowers program in improving the school environment, student knowledge, behavior, cardiovascular fitness levels, and Body Mass Index (BMI).MethodsThe present analysis utilizes data from 40 schools that worked with HealthMPowers over the course of the 2012 – 2013 school year (including schools at each of the three years of the intervention period) and provided information on demographics, student knowledge and behaviors, BMI, performance on the PACER test of aerobic capacity, and school practices and policies (measured via school self-assessment with the HealthMPowers-developed instrument “Continuous Improvement Tracking Tool” or CITT), measured at the beginning and end of each school year. Paired two-sample T tests were used to compare continuous variables (e.g., student knowledge scores, BMI-for-age Z scores), while chi-squared tests were used to assess categorical variables (e.g., trichotomized PACER performance).ResultsStudents across all grades and cohorts demonstrated improvements in knowledge and self-reported behaviors, with particularly significant improvements for third-graders in schools in the second year of the HealthMPowers program (p < 0.0001). Similarly, decreases were observed in BMI-for-Age Z scores for this cohort (and others) across grades and gender, with the most significant decreases for students overweight or obese at baseline (p < 0.0005). Students also showed significant increases in performance on the PACER test across grades and cohorts (p < 0.0001). Lastly, schools tended to improve their practices over time, as measured via the CITT instrument.ConclusionsThe present report demonstrates the effectiveness of the HealthMPowers program in producing positive change in school policies and practices, student knowledge and behaviors, and student fitness and BMI, supporting the use of holistic interventions to address childhood obesity.

Nutrition Education and Body Mass Index in Grades K‐12: A Systematic Review

“…Nutrition and physical activity lessons were incorporated into the regular classroom curriculum. In fourth and fifth graders who were overweight or obese at the baseline measurement, BMI for age z‐score (see summary table) significantly decreased (p < .0001) . Three studies reported nonsignificant changes or no change in BMI percentiles …”

“…Table reports details of studies measuring the effect of nutrition education on BMI grades K‐5. In interventions that took place in schools attended by children in grades K‐5, 4 studies demonstrated a statistically significant decrease in the measured BMI percentile, primarily a decrease in the overweight/obese categories in the participants . Interventions of longer duration had more effect on students' BMI …”

“…The HealthMPowers data study done by Burke et al examined a program based on CDC guidelines for establishing behaviors of healthy eating and physical activity. Nutrition and physical activity lessons were incorporated into the regular classroom curriculum.…”

“…In interventions that took place in schools attended by children in grades K-5, 4 studies demonstrated a statistically significant decrease in the measured BMI percentile, primarily a decrease in the overweight/obese categories in the participants. [8][9][10][11] Interventions of longer duration had more effect on students' BMI. [9][10][11] Spiegel and Foulk reported that the integration of health and nutrition topics into math, science, and language arts classroom lessons that utilized a curriculum based on the health behavior Theory of Reasoned Action resulted in an increase (63.7% to 65.7%, p = .001) in the percentage of students with healthy BMI percentiles at the end of the intervention.…”

“…[8][9][10][11] Interventions of longer duration had more effect on students' BMI. [9][10][11] Spiegel and Foulk reported that the integration of health and nutrition topics into math, science, and language arts classroom lessons that utilized a curriculum based on the health behavior Theory of Reasoned Action resulted in an increase (63.7% to 65.7%, p = .001) in the percentage of students with healthy BMI percentiles at the end of the intervention. 8 Foster et al's 9 study aimed to deliver 50 hours of nutrition education during the school year via interdisciplinary methods based on the Food and Nutrition Services (FNS) and the US Centers for Disease Control and Prevention (CDC) education programs in combination with school nutrition policy changes, social marketing, and parental involvement.…”