Reducing Obesity via a School-Based Interdisciplinary Intervention Among Youth

Abstract

To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grades 6 to 8. Design: Randomized, controlled field trial with 5 intervention and 5 control schools. Outcomes were assessed using preintervention (fall 1995) and follow-up measures (spring 1997), including prevalence, incidence, and remission of obesity.Participants: A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities.Intervention: Students participated in a school-based interdisciplinary intervention over 2 school years. Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education. Sessions focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity.Main Outcome Measures: Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age-and sex-specific 85th percentiles. Because schools were randomized, rather than students, the generalized estimating equation method was used to adjust for individuallevel covariates under cluster randomization.Results: The prevalence of obesity among girls in intervention schools was reduced compared with controls, controlling for baseline obesity (odds ratio, 0.47; 95% confidence interval, 0.24-0.93; P = .03), with no differences found among boys. There was greater remission of obesity among intervention girls vs control girls (odds ratio, 2.16; 95% confidence interval, 1.07-4.35; P = .04). The intervention reduced television hours among both girls and boys, and increased fruit and vegetable consumption and resulted in a smaller increment in total energy intake among girls. Reductions in television viewing predicted obesity change and mediated the intervention effect. Among girls, each hour of reduction in television viewing predicted reduced obesity prevalence (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; P = .02). Conclusion:Planet Health decreased obesity among female students, indicating a promising school-based approach to reducing obesity among youth.

Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis

“…50 Programs appear to have been enhanced when physical activity was not merely encouraged, but made a routine part of the school day. 45,51,53 Very few studies focusing on TV reduction were available at the time this review was conducted 52,55 and only one was amenable to computation of effect size. 55 This strategy remains appealing despite the relative paucity of data and deserves further attention.…”

“…Common strategies included: parent or family member participation; [37][38][39][40][41][42][43][44][45] changing the physical environment; 43,44,[46][47][48] [37][38][39] and student training in behavioral techniques such as self-monitoring. 38,39,52,53 Detailed descriptions of each study can be found in Table 1.…”

Children with a TV in their bedroom at higher risk for being overweight

“…9 To reduce child overweight status, successful interventions have included limiting the amount of time spent in front of the television. [46][47][48][49][50] However, it is difficult to consistently monitor and limit TV viewing time over the long term. A simple and effective screen for child risk factors for overweight that could be employed by pediatricians and other health-care providers would be to ask if a child has a TV in his or her bedroom.…”

Physical activity and sedentary behavior: a review of longitudinal studies of weight and adiposity in youth

“…Several intervention studies have evaluated the impact of increased physical activity or decreased sedentary behavior as part of multifactorial interventions on prevention of weight/fatness gains or remission of overweight in clinical and community-based settings, with mixed results. [4][5][6][7][8][9] One small pilot study that focused only on decreasing sedentary behavior yielded significant results, 10 providing experimental evidence that sedentary behavior is causally linked to overweight. After briefly summarizing select cross-sectional studies, we review prospective research on the role of physical activity and inactivity in the development of obesity or increased relative weight, in children and adolescents, and highlight some of the methodological challenges and limitations in the literature to date.…”