Effect of an environmental school-based obesity prevention program on changes in body fat and body weight: a randomized trial
Donald A Williamson, Catherine M Champagne, David W Harsha, Hongmei Han, Corby K Martin, Robert L Newton Jr, Melinda S Sothern, Tiffany M Stewart, Larry S Webber, Donna H Ryan, Donald A Williamson, Catherine M Champagne, David W Harsha, Hongmei Han, Corby K Martin, Robert L Newton Jr, Melinda S Sothern, Tiffany M Stewart, Larry S Webber, Donna H Ryan
Abstract
This study tested the efficacy of two school-based programs for prevention of body weight/fat gain in comparison to a control group, in all participants and in overweight children. The Louisiana (LA) Health study utilized a longitudinal, cluster randomized three-arm controlled design, with 28 months of follow-up. Children (N = 2,060; mean age = 10.5 years, SD = 1.2) from rural communities in grades 4-6 participated in the study. Seventeen school clusters (mean = 123 children/cluster) were randomly assigned to one of three prevention arms: (i) primary prevention (PP), an environmental modification (EM) program, (ii) primary + secondary prevention (PP+SP), the environmental program with an added classroom and internet education component, or (iii) control (C). Primary outcomes were changes in percent body fat and BMI z scores. Secondary outcomes were changes in behaviors related to energy balance. Comparisons of PP, PP+SP, and C on changes in body fat and BMI z scores found no differences. PP and PP+SP study arms were combined to create an EM arm. Relative to C, EM decreased body fat for boys (-1.7 ± 0.38% vs. -0.14 ± 0.69%) and attenuated fat gain for girls (2.9 ± 0.22% vs. 3.93 ± 0.37%), but standardized effect sizes were relatively small (<0.30). In conclusion, this school-based EM programs had modest beneficial effects on changes in percent body fat. Addition of a classroom/internet program to the environmental program did not enhance weight/fat gain prevention, but did impact physical activity and social support in overweight children.
Trial registration: ClinicalTrials.gov NCT00289315.
Conflict of interest statement
Conflict of Interest
The authors disclose no conflicts of interest.
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References
- Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–1727.
- Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010;303:242–249.
- Rashid MN, Fuentes F, Touchon RC, Wehner PS. Obesity and the risk for cardiovascular disease. Prev Cardiol. 2003;6:42–47.
- Wadden TA, Osei S. The treatment of obesity: An overview. In: Wadden TA, Stunkard AJ, editors. Handbook of obesity treatment. Vol. 2002. New York: New York: 2002. pp. 229–248.
- National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch Intern Med. 2000;160:898–904.
- Kumanyika SK, Obarzanek E. Pathways to obesity prevention: report of a National Institutes of Health workshop. Obes Res. 2003;11:1263–1274.
- Berkowitz RI, Stunkard AJ. Development of childhood obesity. In: Wadden TA, Stunkard AJ, editors. Handbook of Obesity Treatment. Vol. 2002. Guilford; New York: 2002. pp. 515–531.
- Swinburn BA, de Silva-Sanigorski AM. Where to from here for preventing childhood obesity: an international perspective. Obesity (Silver Spring) 2010;18 (Suppl 1):S4–7.
- Doak C, Heitmann BL, Summerbell C, Lissner L. Prevention of childhood obesity—what type of evidence should we consider relevant? Obesity Reviews. 2009;10:350–356.
- DeBourdeaudhuij I, Cauwenberghe E, Spittaels H, et al. School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obesity Reviews. 2011;12:205–216.
- Zwiauer KF. Prevention and treatment of overweight and obesity in children and adolescents. Eur J Pediatr. 2000;159 (Suppl 1):S56–68.
- Williamson DA, Champagne CM, Harsha D, et al. Louisiana (LA) health: design and methods for a childhood obesity prevention program in rural schools. Contemporary Clinical Trials. 2008;29:783–795.
- Epstein LH, Wrotniak BH. Future directions for pediatric obesity treatment. Obesity (Silver Spring) 2010;18 (Suppl 1):S8–12.
- Lutfiyya MN, Lipsky MS, Wisdom-Behounek J, Inpanbutr-Martinkus M. Is rural residency a risk factor for overweight and obesity for U.S. children? Obesity (Silver Spring) 2007;15:2348–2356.
- Crutzen R, de Nooijer J, Brouwer W, Oenema A, Brug J. Strategies to facilitate exposure to internet-delivered health behavior change interventions aimed at adolescents or young adults: A systematic review. Health Education & Behavior. 2011;38:49–62.
- Sung RY, Lau P, Yu CW, Lam PK, Nelson EA. Measurement of body fat using leg to leg bioimpedance. Arch Dis Child. 2001;85:263–267.
- Lumeng JC, Kaciroti N, Frisvold DE. Changes in body mass index z score over the course of the academic year among children attending Head Start. Acad Pediatr. 2010;10:179–186.
- Williamson DA, Allen HR, Martin PD, Alfonso AJ, Gerald B, Hunt A. Comparison of digital photography to weighed and visual estimation of portion sizes. J Am Diet Assoc. 2003;103:1139–1145.
- Williamson DA, Copeland AL, Anton SD, et al. Wise Mind project: a school-based environmental approach for preventing weight gain in children. Obesity (Silver Spring) 2007;15:906–917.
- Sallis JF, Berry CC, Broyles SL, McKenzie TL, Nader PR. Variability and tracking of physical activity over 2 yr in young children. Med Sci Sports Exerc. 1995;27:1042–1049.
- Parcel GS, Edmundson E, Perry CL, et al. Measurement of self-efficacy for diet-related behaviors among elementary school children. J Sch Health. 1995;65:23–27.
- Vieweg VR, Johnston CH, Lanier JO, Fernandez A, Pandurangi AK. Correlation between high risk obesity groups and low socioeconomic status in school children. South Med J. 2007;100:8–13.
- Gabriele JM, Stewart TM, Sample A, et al. Development of an Internet-Based Obesity Prevention Program for Children. J Diabetes Sci Technol. 2010;4:723–732.
- Sallis JF, McKenzie TL, Alcaraz JE, Kolody B, Hovell MF, Nader PR. Project SPARK. Effects of physical education on adiposity in children. Ann N Y Acad Sci. 1993;699:127–136.
- Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282:1561–1567.
- Davis MM, Gance-Cleveland B, Hassink S, Johnson R, Paradis G, Resnicow K. Recommendations for prevention of childhood obesity. Pediatrics. 2007;120 (Suppl 4):S229–253.
- Williamson DA, Walden HM, White MA, et al. Two-year internet-based randomized controlled trial for weight loss in African-American girls. Obesity (Silver Spring) 2006;14:1231–1243.
- Williamson DA, Walden H, York-Crowe E, Stewart TM. Internet-based treatment for pediatric obesity. In: Sothern M, Gordon S, von Almen T, editors. Handbook of Pediatric Obesity: Clinical Management. CRC Press; Boca Raton, FL: 2006. pp. 201–207.
- Newton RL, Thomson J, Rau K, Duhe’ S, Sample A, Williamson DA. LA Health: Description of the development of process measures. American Journal of Health Promotion. in press.
- Williamson DA, Champagne CM, Han H, et al. Increased obesity in children living in rural communities of Louisiana. Int J Pediatr Obes. 2009;4:160–165.
- Cohen J. Statistical power analysis for the behavioral sciences. 2. Hillsdale, NJ: Erlbaum; 1988.
- Cohen J. The earth is round (p <05) Amer Psychologist. 1994;49:997–1003.
- Cortina JM, Landis RS. The earth is not round (p =00) Organizational Research Methods. 2011;14:332–349.
- Hedges LV. Effect sizes in cluster-randomized designs. J of Educational and Behaioral Staistics. 2007;32:341–370.
- Rosnow RL, Rosenthal R. Focused tests of significance and effect size estimation in counseling psychology. J of Counseling Psych. 1988;35:203–208.
- Healthy Study Group. A school-based intervention for diabetes risk reduction. N Engl J Med. 2010;363:443–453.
- Bartholomew JB, Jowers EM. Increasing frequency of lower-fat entrees offered at school lunch: an environmental change strategy to increase healthful selections. J Am Diet Assoc. 2006;106:248–252.
- Cunningham-Sabo L, Snyder MP, Anliker J, et al. Impact of the Pathways food service intervention on breakfast served in American-Indian schools. Prev Med. 2003;37:S46–54.
- Luepker RV, Perry CL, McKinlay SM, et al. Outcomes of a field trial to improve children’s dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. JAMA. 1996;275:768–776.
Source: PubMed