# Exercise as it relates to Disease/The Impact of an Interdisciplinary School-Based Health Behaviour Intervention on Obesity Among Youth

Please Note: This analysis is inclusive of the impact school-based health behaviour has on obesity among youth. The contents have been composed entirely in the context of one article ‘Reducing Obesity via a School-Based Interdisciplinary Intervention Among Youth’ (Gortmaker et al.,1999).

## What is the background to this research?

The World Health Organisation defined overweight and obesity as the accumulation of abnormal or excessive fat that may contribute to impaired health. Childhood obesity is now recognised as a chronic disease as it is unable to be treated, or cured through medicine, and remains a persisting illness. This study focussed on the reduction of obesity through the implementation of a school-based interdisciplinary intervention known as Planet Health.

### Prevalence

Obesity is a considerable cause of excess morbidity and mortality, making it societal health epidemic. The prevalence of children and adolescence overweight or obese has risen significantly, most notably within economically developed countries. In 2014, an estimated 41 million children below five were overweight or obese. This often continues into adolescence with obesity values for children 6–11 years in the US increasing from 7% in 1980, to nearly 18% in 2012. During the same period, the increment in obese adolescence increased from 5% to 21%.

## Where is the research from?

This study was conducted within 5 schools situated in Boston, with evidence derived from research professors of ‘The Department of Health and Social Behaviour’. Despite members receiving academic and research awards they might be under time, or expense constraints which could implicate research. Studies of this nature are often supported by external sources in this case, the National Institutes of Child Health and Human Development and Centers of Disease Control and Prevention, which could have caused bias results.

### Conflicts of Interest

Results have been used within the development of ‘Planet Health’, a profitable interdisciplinary curriculum. This commercial application may have introduced a bias, as data demonstrating successive of such an intervention is favourable.

## What kind of research was this?

This was a randomised control trial (RCT) with 5 intervention and 5 control schools, employing pre-intervention and follow-up measures to assess prevalence, incidence and remission of obesity. Importantly, a RCT is one of the highest levels of evidence within research and findings considered valuable. The evidence is thorough with many variables, protocols and research considered such as, their implementation of social and behavioural skills derived from the Social-cognitive theory. Their classification of obesity was based on body mass index and triceps skin-folds, as guidelines recommend a collaboration of both.

## What did the research involve?

This study involved the participation of students, grades 6-8 in a school-based intervention over two-years and was implemented within the curriculum using classroom and physical education teachers. Innovative, student centred methods were used to promote behavioural change, which coincided with participation in physical education sessions inclusive of self-assessments of activity and inactivity and replacement of inactive time with moderate to vigorous activity. The methodology employed was the most appropriate considering the intervention needed to pertain to adolescents at a school-wide level.

### Limitations

A notable methodological concern was the potential for measurement error within assessment of obesity, however use of a composite indicator should reduce miscalculation. Further, the application of self-report measures poses concern of inaccuracy.

## What were the basic results?

Anthropometric data demonstrated obesity prevalence among female students within control schools increased, opposed to intervention schools where prevalence declined. Prevalence for boys among both schools did not demonstrate a significant difference. Markedly, the largest effects were among African American girls, where prevalence significantly declined. When examining impact on behavioural change, intervention schools demonstrated a reduction in television viewing, and among these girls a decrease in daily intake with heightened consumption of fruit and vegetables.
| Obesity Prevalence % | Baseline (Female) | Follow-Up (Female) | Baseline (Male) | Follow-Up (Male) |
| Control | 21.5 | 23.7 | 34.7 | 31.8 |
| Intervention | 23.6 | 20.3 | 29.3 | 27.8 |

### Interpretation of Results

Researchers hypothesised the lack of an intervention effect among boys was due to girls being more attuned to diet and activity issues, and that behavioural data validates the importance of television viewing on obesity. They also state, the intervention decreased obesity prevalence among females, and restraint from generalising to all students gives validity to their findings.

## What conclusions can we take from this research?

This study concludes reiterating the program demonstrates a promising approach to reducing obesity among youth, which is true and imperative considering the prevalence. However, more research is necessary to ensure successiveness is widespread. Television viewing is considered one of the most modifiable causes of obesity among children and this study demonstrated a reduction in viewing hours and an association with reduced obesity prevalence. This is supported as research indicates an association between television viewing and adiposity among children younger than ten. However, less justified in adolescence, as among adolescent girls, viewing time demonstrates an insignificant association with adiposity or physical activity. This is reiterated with mixed results in older children and the suggestion other factors are involved.

## Practical advice
### Real world implications

This research enhances the understanding of behavioural factors that influence obesity prevalence, demonstrating that such an intervention has the capacity to reduce obesity prevalence among girls, increase fruit and vegetable consumption and decrease daily intake. It positively reduced television viewing time among both genders, as there is a prominent association between television viewing and metabolic risk. This research demonstrates the necessity for a population based effort in combatting obesity and signifies the capability of schools as a channel for institutionalising programs within the community. Many school-based interventions focus on reducing cardiovascular risk with insignificant impacts on obesity and so, introduction of additional research would prove beneficial.

### Considerations

Providing students with cognitive and behavioural skills to enable changes should be done with caution as commonly youth, especially females are susceptible to extreme dieting practices. There is little evidence demonstrating the impact of these changes over time and so execute vigilance if implicating this advice. Further, reduction in obesity is multi-factorial and subject to individual variation, also consider this focussed on changing behaviour from a school-based approach, and is not inclusive of family or home support. Encompassing this is imperative as studies for obese children observed significant effects when children and parents were targeted and reinforced for weight loss.

## Further information/resources
### Further reading

For further information on Obesity, and both its prevalence within youth and its relationship with physical activity please read below, or refer to references:
* Family Based Interventions: https://www.researchgate.net/profile/Manfred_Mueller3/publication/7782187
* Role of Physical Activity: https://www.researchgate.net/profile/Michael_Goran/publication/12931038
* Health Consequences: http://pediatrics.aappublications.org/content/101/Supplement_2/518.short
* Role of Parents in Prevention: http://files.eric.ed.gov/fulltext/EJ795887.pdf
* Prevalence and Prevention: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1208949/

### References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, Laird N. Reducing Obesity via a School-Based Interdisciplinary Intervention Among Youth: Planet Health. Archives of Pediatrics and Adolescent Medicine Journal 1999; 153(4): 409-418.
* 1 2 3 World Health Organisation. Obesity and Overweight. http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed 24th August 2016).
* ↑ Farpour-Lamberta NJ, Bakerb JL, Hassapidoud M, Holme JC, Nowickaf P, O’Malley G, Weissh R. Childhood Obesity Is a Chronic Disease Demanding Specific Health Care – a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). Obesity Facts - The European Journal of Obesity 2015; 8(1): 342–349.
* ↑ Shields M. Overweight and Obesity Among Children and Youth. Health Reports 2006; 17(3): 27-42.
* 1 2 Centres for Disease Control and Prevention. Obesity Prevention: Healthy Schools - Childhood Obesity Facts. https://www.cdc.gov/healthyschools/obesity/facts.htm (accessed 24th August 2016).
* ↑ Burns P, Rohrich R, Chung K. The Levels of Evidence and their role in Evidence-Based Medicine. Plastic and Reconstructive Surgery 2011; 128(1): 305–310.
* ↑ Bandura A . Social Foundations of Thought and Action: A Social Cognitive Theory, 1st ed. National Institution of Mental Health Rockville, Englewood Cliffs: Prentice Hall; 1986.
* ↑ Organisation for Economic Co-operation and Development. Glossary of Statistical Terms - Composite Indicator. https://stats.oecd.org/glossary/detail.asp?ID=6278 (accessed 24th August 2016).
* ↑ Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M. A Comparison of Direct versus Self-report Measures for Assessing Physical Activity in Adults: a Systematic Review. International Journal of Behavioral Nutrition and Physical Activity 2008; 56(5): 1-24.
* ↑ Robinson TN. Television Viewing and Childhood Obesity. Pediatric Clinics of North America 2001; 48(4): 1017–1025.
* 1 2 Rey-Lopez JP, Vicente-Rodriguez G, Biosca M, Moreno LA. Sedentary Behaviour and Obesity Development in Children and Adolescents. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD 2008; 18(3): 242-251.
* ↑ Robinson TN, Hammer LD, Wilson DM, Killen JD, Kraemer HC, Hayward C, Taylor CB. Does Television Viewing Increase Obesity and Reduce Physical Activity? Cross-sectional and Longitudinal Analyses Among Adolescent Girls. Paediatrics 1993; 91(2): 273-280.
* ↑ Ekelund U, Brage S, Froberg K, Harro M, Anderssen SA, Sardinha LB, Riddoch C, Andersen LB. TV Viewing and Physical Activity Are Independently Associated with Metabolic Risk in Children: The European Youth Heart Study. PLOS Medicine 2006; 3(12): 488-491.
* ↑ Zullig K, Ubbes VA, Pyle J, Valois RF. Self‐Reported Weight Perceptions, Dieting Behaviour, and Breakfast Eating Among High School Adolescents. Journal of School Health 2006; 76(3): 87-92
* ↑ Epstein LH, Valoski A, Wing R, McCurley J. Ten-year Outcomes of Behavioural Family-Based Treatment for Childhood Obesity. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association 1994; 13(5): 373-383.