# Exercise as it relates to Disease/Reducing obesity through school based interventions
## Background to the Research

The range of obesity among children throughout the United states has been rapidly growing over the last 30 years due to the fact that it is the most common nutritional disorder in this age bracket. Due to the complex nature of obesity it can be hard to set prevention strategies as it relates to both genetic and environmental factors, but the general consensus is that obesity ultimately results from an imbalance of energy intake from their diet intake. It's for this reason that planet health attempted this research trial throughout the schools to try and find a successful strategy to help prevent obesity in adolescents.

## Where Is The Research From

This research was carried out by Planet Health across the United States through both year 6 and year 7 from five public schools in four Boston communities. Schools sent consent letters to all the schools involved in the trials to give students the choice to be a part of the research.

## Where Kind Of Research Was This

In this trial there were ten schools in total, five of which were the intervention schools and the other five were the controlled schools. The total number of students that participated in the research was 1295. To evaluate overall progress of the students a body mass index was done as well as a triceps skin fold test which was compared to an age and sex specific 85th percentiles. To know what the students did in regards to food, physical activity and diet measurements a survey was done in class under supervision by a trained teacher. Physical activity was assessed using a youth activity questionnaire which contained 16 questions to gain a rough idea of many hours during the day were spent in the moderate and vigorous intensities. Dietary intake was an assessment of how much fruit and vegetables the students consumed. Due to the randomizing of schools an estimating equation was used in order to adjust individual level if needed. These progress tests were taken in Autum of 1995 and Spring 1997.

## What Did The Research Involve

The research involved a two year commitment by the schools which they then integrated planet health sessions within the already existing curricula using both teachers and PE teachers. Each school that held the intervention received teacher training workshops through a planet health program, PE materials, fitness funds, wellness sessions. These sessions were mainly focusing around reducing the amount of television being watched and decreasing high fat foods and trying to replace them with fruit and vegetables. By implementing both these factors planet health then increased the moderate and vigorous physical activity. The primary aim for an individual was to focus on how to counter obesity and the secondary aims included self reports of how much television they watched, moderate and high intensity exercise, the total percentage of their dietary intake from fat, servings of fruit and vegetables and the total energy intake. Due to the change of eating and activity patterns throughout the year during the warmer and colder seasons data was collected at the same time to remove any bias estimates.

## Where Were The Basic Results

The results from this research mainly produced positive results amongst the girls compared to the boys. The same results for both boys and girls were found when reducing television hours and healthier eating using fruit and vegetables. The difference that we found with the girls during this study showed that they had greater confidence in themselves and had greater understanding in how to avoid obesity. The big factor that this school intervention proved was that with each hour taken out of television watching, reduced the prevalence of obesity amongst girls. There were a few limitations with regards to this study these included the overall participation rate was lower than I would have thought which was probably due to some schools asking for written consent. Randomization meant that it was unbalanced allowing similar outcome observations throughout the schools. Measurement error was a factor with the variance in maturation throughout the boys which could have impacted negatively on the test but in the end there was no evidence to suggest this theory was right. And the last limitation that I found was that further research is required in order to decide whether these positive changes for females would continue after the test finished, that way schools could start implementing this within the school.

## Conclusions

This was one of the first randomized controlled trials carried out as a school intervention in trying to reduce obesity in adolescents. This unfortunately showed due the lack of effect among the boys, meaning that a different intervention strategy is needed in order to provide the same results for the boys as was done by the girls. A possible reason why this intervention worked on the girls could be that they are more self conscious and are more receptive to issues of diet and the need to do exercise . The conclusion we can draw from this research is that the Planet health study decreased obesity throughout the female students over two years, providing a promising possibility to start implementing a school based response reducing obesity throughout the youth via regular classroom activities.

## Practical Advice

The advice I have after reading this research paper is that more resources should be put into funding school based interventions as this will help find a strategy we could use worldwide, and effectively stopping majority of the obesity cases we currently have which is only increasing each year. Because of the positive effect that the female students had with the strategies implemented by planet health in regards to television viewing and listening to the dietary requirements I feel that reducing the amount of electronic screen time in adolescents can only produce positive outcomes in trying to get adolescents doing physical activity.

## Further Information/ Resources

There are numerous websites/ research articles linked to the main web page in the references area that the reader may find interesting. These are easy to find and the page is easy to navigate.

## References

* ↑ Gortmaker SLDietz WH JrSobol AMWehler CA Increasing pediatric obesity in the United States. AJDC. 1987;141535- 540,Troiano RPFlegal KMKuczmarski RJCampbell SMJohnson CL Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med. 1995;1491085- 1091Article
* ↑ Rosenbaum, MLeibel, RHirsch J Obesity .N Engl J Med. 1997;337396-4087 Article
* ↑ Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; et al. Reducing Obesity via a school based intersisiplanery Intervention Among Youth, Planet Health April 1999, http://jamanetwork.com/journals/jamapediatrics/fullarticle/346206
* ↑ Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; et al. Reducing Obesity via a school based intersisiplanery Intervention Among Youth, Planet Health April 1999, http://jamanetwork.com/journals/jamapediatrics/fullarticle/346206
* ↑ Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; et al. Reducing Obesity via a school based intersisiplanery Intervention Among Youth, Planet Health April 1999, http://jamanetwork.com/journals/jamapediatrics/fullarticle/346206
* ↑ Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; et al. Reducing Obesity via a school based intersisiplanery Intervention Among Youth, Planet Health April 1999, http://jamanetwork.com/journals/jamapediatrics/fullarticle/346206
* ↑ Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; et al. Reducing Obesity via a school based intersisiplanery Intervention Among Youth, Planet Health April 1999, http://jamanetwork.com/journals/jamapediatrics/fullarticle/346206
* ↑ Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; et al. Reducing Obesity via a school based intersisiplanery Intervention Among Youth, Planet Health April 1999, http://jamanetwork.com/journals/jamapediatrics/fullarticle/346206
* ↑ Dietz WHGortmaker SL Factors within the physical environment associated with childhood obesity. Am J Clin Nutr. 1984;39619- 624
* ↑ Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; et al. Reducing Obesity via a school based intersisiplanery Intervention Among Youth, Planet Health April 1999, http://jamanetwork.com/journals/jamapediatrics/fullarticle/346206
* ↑ Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; et al. Reducing Obesity via a school based intersisiplanery Intervention Among Youth, Planet Health April 1999, http://jamanetwork.com/journals/jamapediatrics/fullarticle/346206