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A Policy-Based School Intervention to Prevent Overweight and Obesity
Abstract
BACKGROUND. The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic settings. Schools are ideal settings for population-based interventions to address obesity. OBJECTIVE. The purpose of this work was to examine the effects of a multicomponent, School Nutrition Policy Initiative on the prevention of overweight (85.0th to 94.9th percentile) and obesity (>95.0th percentile) among children in grades 4 through 6 over a 2-year period. METHODS. Participants were 1349 students in grades 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with ≥50% of students eligible for free or reduced-price meals. Schools were matched on school size and type of food service and randomly assigned to intervention or control. Students were assessed at baseline and again after 2 years. The School Nutrition Policy Initiative included the following components: school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach. RESULTS. The incidences of overweight and obesity after 2 years were primary outcomes. The prevalence and remission of overweight and obesity, BMI z score, total energy and fat intake, fruit and vegetable consumption, body dissatisfaction, and hours of activity and inactivity were secondary outcomes. The intervention resulted in a 50% reduction in the incidence of overweight. Significantly fewer children in the intervention schools (7.5%) than in the control schools (14.9%) became overweight after 2 years. The prevalence of overweight was lower in the intervention schools. No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years. CONCLUSION. A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grades 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals.
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“Another cluster-randomized trial in 10 US schools evaluated a comprehensive educational initiative that included school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach.238 After 2 years, the intervention lowered the incidence of overweight by 50% (7.5% versus 14.9%).”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [238]
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“The SNPI, developed and delivered by a community organization, included school association meetings, report card nights, parent education, and nutrition workshops (Foster et al., 2008).”
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“Four nutrition-specific interventions were included in this review, with two studies (93,94) reporting minor positive outcomes.”
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Polonsky, H. M., Bauer, K. W., Fisher, J. O., Davey, A., Sherman, S., Abel, M. L., Hanlon, A. L., Ruth, K. J., Dale, L. C., & Foster, G. D. (2019) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2018.5531 · Cited by 37
Self-citationNutrition education and body mass index in grades k-12: A systematic review
Price, C., Cohen, D., Pribis, P., & Cerami, J. (2017) · Journal of School Health · doi:10.1111/josh.12544 · Cited by 34
van Horn, L. V., Johnson, R. K., Flickinger, B., Vafiadis, D. K., & Yin-Piazza, S. (2010) · Circulation · doi:10.1161/cir.0b013e3181ffdcb0 · Cited by 38
Psychosocial Perspectives and the Issue of Prevention in Childhood Obesity
Stein, D. J., Weinberger-Litman, S. L., & Latzer, Y. (2014) · Frontiers in Public Health · doi:10.3389/fpubh.2014.00104 · Cited by 33
“These include nutrition and education (137), the delivery of frequent and systemized positive messages about eating healthful food and modeling fruit and vegetable consumption (135, 138), changing the types of foods sold and served at school according to accepted guidelines (136–141), reducing the amount of consumptio…”
BackgroundOfosu, N. N., Ekwaru, J. P., Bastian, K. A., Loehr, S. A., Storey, K., Spence, J. C., & Veugelers, P. J. (2018) · BMC Public Health · doi:10.1186/s12889-018-5427-4 · Cited by 31
Eisenmann, J. C., Alaimo, K., Pfeiffer, K. A., Paek, H., Carlson, J. J., Hayes, H., Thompson, T. L., Kelleher, D., Oh, H. J., Orth, J., et al. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-607 · Cited by 31
“Thus, there is an important need to focus intervention on these groups of children [4]; however, few intervention studies have focused on low-income and/or minority children [5-10].”
BackgroundRobbins, L. B., Ling, J., Clevenger, K. A., Voskuil, V. R., Wasilevich, E. A., Kerver, J. M., Kaciroti, N., & Pfeiffer, K. A. (2018) · The Journal of School Nursing · doi:10.1177/1059840518791290 · Cited by 34
“…no between-group differences occurred in adolescents’ MVPA at postintervention; however, a close-to-moderate effect size did emerge that was higher than the trivial–small effect sizes noted for PA by Foster et al. (2008) to be .03 and by Lubans, Morgan, Aguiar, and Callister (2011) to be .20.”
BackgroundInfluentialEffects of total fat intake on bodyweight in children
Naude, C. E., Visser, M. E., Nguyen, K. A., Durão, S., & Schoonees, A. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012960 · Cited by 33
Morales, M. A. E. P., Bacardí‐Gascón, M., Jiménez–Cruz, A., & Armendariz-Anguiano, A. L. (2009) · PubMed · Cited by 31
Promoting Energy-Balance Behaviors Among Ethnically Diverse Adolescents
Springer, A. E., Kelder, S. H., Byrd-Williams, C. E., Pasch, K. E., Ranjit, N., Delk, J., & Hoelscher, D. M. (2012) · Health Education & Behavior · doi:10.1177/1090198112459516 · Cited by 35
“To date, only a handful of school-based obesity-related prevention intervention studies have been conducted with U.S. middle school students (Foster et al., 2008; Gortmaker et al., 1999; Healthy Study Group, 2010; Larson et al., 2007; Neumark-Sztainer et al., 2010; Robbins, Gretebeck, Kazanis, &…”
BackgroundFollong, B., Verdonschot, A., Prieto, E., Miller, A., Collins, C. E., & Bucher, T. (2021) · Nutrition Research Reviews · doi:10.1017/s0954422421000111 · Cited by 34
“Only Foster et al. (2008) were able to provide the recommended intensity, with 100 h across 2 academic years(60).”
BackgroundPower-up: a collaborative after-school program to prevent obesity in African American children.
Choudhry, S., McClinton-Powell, L., Solomon, M. C., Davis, D. S., Lipton, R. B., Darukhanavala, A. P., Steenes, A., Selvaraj, K., Gielissen, K. A., Love, L., et al. (2011) · PubMed · Cited by 30
Naylor, P., Olstad, D. L., & Therrien, S. (2015) · Childhood Obesity · doi:10.1089/chi.2014.0148 · Cited by 29
“Self-assessment has proven a strong driver of positive change in similar studies, 27–29 although it is also possible that changes reflect testing effects or reporting biases.”
Taber, D. R., Chriqui, J. F., Powell, L. M., Perna, F. M., Robinson, W. R., & Chaloupka, F. J. (2015) · Journal of School Health · doi:10.1111/josh.12288 · Cited by 29
The role of Indian school canteens in nutrition promotion
Rathi, N., Riddell, L. J., & Worsley, A. (2017) · British Food Journal · doi:10.1108/bfj-05-2017-0275 · Cited by 29
Sarwer, D., & Dilks, R. (2011) · Journal of Youth and Adolescence · doi:10.1007/s10964-011-9677-z · Cited by 32
“Instead, ‘‘at risk of overweight’’ is used to describe youth between the 85th and 94th BMI percentile and ‘‘overweight’’ is used for those above the 95th percentile ( Dietz and Bellizzi 1999; Kuczmarski et al. 2002).”
Waqa, G., Moodie, M., Schultz, J. T., & Swinburn, B. A. (2013) · Global Health Promotion · doi:10.1177/1757975913501909 · Cited by 28
“This was coupled with a considerable gap in top-down policy approaches from the MoE; for example, canteen guidelines were not enforced and the absence of clear ministerial directions made it difficult to effect change in the types of foods available in the schools (42).”
BackgroundGiralt, M., Albaladejo, R., Tarro, L., Moriña, D., Arija, V., & Solà, R. (2011) · Trials · doi:10.1186/1745-6215-12-54 · Cited by 29
“Although some school-based interventions have had positive effects on overweight and/or obesity [10-12] most, particularly those involving large cohorts [13-15], have not.”
BackgroundKoch, P. A., Contento, I. R., Gray, H. L., Burgermaster, M., Bandelli, L. N., Abrams, E., & Noia, J. D. (2019) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2018.12.001 · Cited by 28
The rising prevalence of obesity: part B—public health policy solutions
Agha, M., & Agha, R. (2017) · International Journal of Surgery Oncology · doi:10.1097/ij9.0000000000000019 · Cited by 27
Molitor, F., Sugerman, S. B., Yu, H., Biehl, M. C., Aydin, M. H., Levy, M., & Ponce, N. A. (2015) · Preventing Chronic Disease · doi:10.5888/pcd12.140449 · Cited by 27
Santos-Beneit, G., Bodega, P., de Miguel, M., Rodríguez, C., Carral, V., Orrit, X., Haro, D., Carvajal, I., de Cos-Gandoy, A., Peñalvo, J. L., et al. (2019) · American Heart Journal · doi:10.1016/j.ahj.2018.12.011 · Cited by 29
“Previous school-based intervention trials in this age group have shown conflicting results.(42-45) Two recent”
ResultNury, E., Stadelmaier, J., Morze, J., Nagavci, B., Grummich, K., Schwarzer, G., HOFFMANN, G. E., Angele, C. M., Steinacker, J. M., Wendt, J., et al. (2022) · BMJ Medicine · doi:10.1136/bmjmed-2022-000346 · Cited by 34
Building school-based cardiovascular health promotion capacity in youth: a mixed methods study
Woodgate, R. L., & Sigurdson, C. M. (2015) · BMC Public Health · doi:10.1186/s12889-015-1759-5 · Cited by 28
Roccaldo, R., Censi, L., D’Addezio, L., Canani, S. B., & Gennaro, L. (2017) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2017.1303826 · Cited by 26
“Many studies show that the school environment has the potential to affect children’s attitudes, preferences, and behavior (Keihner et al. 2001; De Sa & Lock 2008; Fahlman et al. 2008; Foster et al. 2008; Jaime & Lock 2009; Grassi et al. 2016).”
BackgroundHan, G., & Liu, P. (2017) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2017.07.002 · Cited by 26
da Silva, K. B. B., Ortelan, N., Murta, S. G., Sartori, I., Couto, R. D., Fiaccone, R. L., Barreto, M. L., Jones, M., Taylor, C. B., & Ribeiro‐Silva, R. D. C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16101674 · Cited by 32
“The analyses adjusted for the following variables: sex, age, economic condition, caregiver education, physical activity level, and pubertal development [2,15,49].”
Background
Metadata
- Authors
- Foster, G. D., Sherman, S., Borradaile, K. E., Grundy, K. M., Vander Veur, S. S., Nachmani, J., Karpyn, A., Kumanyika, S., & Shults, J.
- Affiliations
- Temple University (US)
- The Food Trust (US)
- Bryn Mawr College (US)
- Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania
- School District of Philadelphia (US)
- University of Pennsylvania (US)
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2008-04-01
- Volume
- 121
- Issue
- 4
- Pages
- e794-e802
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2167662032
- Cited by
- 496
- References
- 34
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 9 · 2023: 14 · 2022: 16 · 2021: 36 · 2020: 14 · 2019: 22 · 2018: 22 · 2017: 27 · 2016: 19 · 2015: 46 · 2014: 35 · 2013: 39 · 2012: 55
- FWCI
- 44.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (R06/CCR321534-01)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- childhood obesity prevention, overweight prevention, school-based intervention, nutrition policy, school nutrition, nutrition education, social marketing, parent outreach, school self-evaluation, BMI z-score, fruit and vegetable intake, energy intake, dietary fat intake, physical activity, body dissatisfaction, urban public schools, low-income children
- MeSH terms
- Adolescent, Child, Child Health Services, Child Nutritional Physiological Phenomena, Female, Health Promotion, Humans, Male, Obesity, Policy Making, Probability, School Health Services, Sensitivity and Specificity, Program Evaluation, Incidence, Confidence Intervals, Odds Ratio, Age Distribution, Sex Distribution, Risk Assessment, Overweight
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