Over one third of U.S. youth are overweight or obese. Treatments typically have had unreliable effects, inconsistently incorporating behavior-change theory. After-school care might be a viable setting for health behavior-change programs. We evaluated effects of two consecutive 12-week segments of a revised self-efficacy/ social cognitive theory-based physical activity and nutrition treatment on fitness levels, body mass index (BMI), and targeted psychosocial factors in after-school care participants, ages 5-8 years. Changes in physiological measures, exercise self-efficacy (ESE), and physical selfconcept over 9 months were contrasted in experimental (n=72) vs. typical-care (n=42) groups. Mediation of the group-BMI change relationship by the psychosocial factors was also assessed. Improvements in physiological measures and ESE were significantly greater in the experimental group. ESE change completely mediated the association of treatment type with BMI change. The experimental group demonstrated significantly greater improvements in the physiological measures, with its treatment's theoretical basis and application within afterschool care supported.
KeywordsBMI, Physical activity, Psychological factors, Youth, Self-efficacy, ChildrenThe prevalence of children being either overweight (body mass index (BMI; kg/m 2 )≥85th<95th sex-and age-adjusted percentile) or obese (≥95th percentile) [1] is an increasing concern in industrialized nations [2]. A high weight at a young age predicts overweight, obesity, and increased health risks into and throughout adulthood [2][3][4].U.S. government data indicate that approximately 35 % of White children of ages 6 through 11 years are either overweight or obese, with their African-American and Hispanic counterparts higher at an average of about 40 % [5]. Although adequate physical activity and a healthy diet will promote a healthy weight, children now consume a preponderance of unhealthy foods that are high in fat, sugar, and calories [6], and active free-play has been reduced through increased screen time and parents' concerns for safety when unsupervised [7]. Although recess provided in elementary schools varies by state, schools have a clear opportunity to increase physical activity levels and improve nutrition in children of that age group [7,8]. However, they have been either unwilling or unable to consistently provide healthy foods [6], and even when physical education (P.E.) time has not been reduced (as has been a trend [8]), moderate-to-vigorous physical activity during such classes has been minimal [9] with only 8 to 11 % of a child's daily physical activity provided by P.E. [10]. Accelerometer-measured data indicate that for U.S. children of ages 6 through 11 years, only about half the boys and one third of the girls attain the recommended amount of moderate or more intense physical activity of 60 min/day, 5 or more days per week [11]. Implications Practice: For young elementary school students, after-school care can, and should, provide moderate-to-vigorous phys...