Trends in health behavior and weight outcomes following enhanced afterschool programming participation

Jessica Rieder, Jee-Young Moon, Joanna Joels, Viswanathan Shankar, Paul Meissner, Elicia Johnson-Knox, Bailey Frohlich, Shelby Davies, Judy Wylie-Rosett, Jessica Rieder, Jee-Young Moon, Joanna Joels, Viswanathan Shankar, Paul Meissner, Elicia Johnson-Knox, Bailey Frohlich, Shelby Davies, Judy Wylie-Rosett

Abstract

Background: The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities. Although recommended, schools have difficulty consistently implement evidence-based obesity programing. We report on the effectiveness of adding structured nutrition education and minimum physical activity (PA) requirements to standard middle school after-school programming.

Methods: Using a longitudinal pre-post study design, we evaluated program effectiveness at one year on target behaviors on students recruited during three consecutive school years (2016-2018). We used generalized linear (or logistic) mixed-effects modeling to determine: 1) impact on healthy weight and target healthy behavior attainment, and 2) whether target behavior improvement and weight change were associated with after-school program attendance. The seven target behaviors relate to eating healthy, physical activity, and sleep.

Results: Over the three years, a total of 76 students enrolled and completed one year of programming (62% Hispanic, 46% girls, 72% with BMI > 85th %ile, 49% with BMI > 95th %ile). Of students with BMI > 85th %ile, 44% maintained or decreased BMI Z-score. There were improvements (non-significant) in BMI Z-score and the adoption of four healthy eating behaviors: fruit, vegetables, sugar-free beverages, and unhealthy snack food. Students with higher after-school attendance (> 75%) had greater improvements (non-significant) in composite behavior scores, BMI Z-score, and in most target behaviors (5/7) than students with lower after-school attendance (< 75%). Sleep improvements were significantly associated with BMI Z-score decrease (Beta = - 0.05, 95% CI (- 0.1,-0.003), p = 0.038.) CONCLUSIONS: Enhancement of existing after-school programming with structured nutrition education and minimum physical activity requirements demonstrates positive improvements in several health behaviors and weight outcomes. Adopting enhanced after-school programming increases access to health activities and may bring us closer to solving obesity in at-risk youth in impoverished communities.

Trial registration: ClinicalTrials.gov identifier (NCT number): NCT03565744 . Registered 21 June 2018 - Retrospectively registered.

Keywords: Adolescent obesity; Afterschool programming; Healthy eating; Physical activity; School health; Sleep; Target behaviors; Wellness Cascade.

Conflict of interest statement

Viswanathan Shankar is a Senior Board Member for BMC Public Health. The authors declare that they have no competing interests. All authors of declare that there is no conflict of interest regarding the publication of this article and this article has not been published elsewhere.

Figures

Fig. 1
Fig. 1
Proportions of Students Attaining Step Milestones Each School Year. Step 1– includes those students assessed; Step 2 includes those students enrolled in B’N Fit POWER; Step 3– includes those students that engaged in the program by attending at least one clinic and one after-school session; Step 4-includes those students that completed the program by attending all three clinics; and Step 5 –includes students who demonstrated either maintenance or an improvement in BMI Z-score. Number of students BMI > 85th%ile are represented within parentheses. *B’N Fit POWER enrollment restricted to 40 students each for 2016 and 2017 and 20 for 2018 based on staffing limitations. The numbers within the parenthesis reflect sub-group students whose BMI ≥85th percentile
Fig. 2
Fig. 2
Composite Target Behavior Score Changes After a Year (N = 76)
Fig. 3
Fig. 3
Proportions of Students Attaining Individual Target Behaviors After One Year (N = 76). Sugar-Free Bev. –Sugar-free beverage consumption; Sugary Bev. –Sugary beverage consumption; SFSB –Sugar-free beverage and sugary beverage consumption; USFF – Unhealthy snack food and fast food consumption. *p = 0.05 by McNeMar’s test. Note: Target behaviors attainment standards according to American Academy of Pediatrics Expert Committee, NHLBI sleep recommendations, Physical Activity Guidelines for Americans 2nd Edition, and USDA MyPlate guidelines

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