School and Family-Based Obesity Prevention for Children
Condition: Cardiovascular Diseases; Heart Diseases; Obesity
MeSH terms: Cardiovascular Diseases; Heart Diseases; Obesity
Study type: Observational

Summary: 
      To conduct an integrated, multiple-component, school- and community-based intervention
      targeting both primary and secondary prevention of obesity among third-fourth-and
      fifth-graders ("School- and Family-Based Obesity Prevention for Children").
    

Detailed description: 
      BACKGROUND:

      An estimated 25-40 percent of United States pre-adolescents and adolescents are obese. Higher
      rates have been noted among minority youth. Onset of obesity in late childhood and early
      adolescence is associated with increased risks of "tracking" of obesity into adulthood,
      subsequent obesity-related morbidity and mortality, and obesity- related psychosocial
      morbidity. However, there is limited ability to accurately identify those children who will
      become obese adults and those who will suffer obesity-related morbidities, Existing
      treatments for child and adolescent obesity have yielded modest, unsustained effects, and
      single-component prevention interventions have been relatively ineffective.

      DESIGN NARRATIVE:

      The intervention model was derived from principles of Bandura's social cognitive theory, and
      included activities in the school, and the home, and a clinically oriented component for
      high-risk children. The school component included: a computer-based classroom curriculum; a
      physical education curriculum; and a school lunch intervention. The home component included
      correspondence materials and a videotape for parents. Children identified as "high risk" were
      eligible to enroll in an intensive intervention. In addition, several innovative approaches
      were included: interventions to influence food preferences and television viewing,
      interventions promoting health advocacy, and computer-assisted instruction.

      An "efficacy trial" evaluated the three-year intervention in a cohort of approximately 1200
      3rd graders, in 14 ethnically diverse elementary schools, with follow-up in the 6th grade. 7
      schools were randomly assigned to the comprehensive intervention, and 7 schools received an
      attention-placebo classroom curriculum. Anthropometric measures and assessments of food
      preferences, cardio-respiratory fitness and self-reported behavior, attitudes and knowledge
      occurred every six months. Parent interviews occurred annually. Although a careful assessment
      of effects on parents and the schools was conducted, the crucial question was whether the
      overall intervention had an impact on student adiposity and behaviors.

      The primary objective was to significantly reduce the prevalence of obesity, compared to
      controls, at the end of the three year intervention. Secondary objectives included
      maintenance of effects at 6-month follow-up, reducing obesity among high-risk children,
      improving cardio-respiratory fitness, increasing physical activity, decreasing sedentary
      activity, reducing the prevalence of unhealthful weight control methods, and improving
      knowledge, attitudes and perceived self-efficacy regarding the adoption of healthful
      behaviors. In addition, the investigators identified personal, behavioral and environmental
      (including family) factors prospectively associated with development of obesity, maintenance
      of normal weight, weight reduction among overweight children and obesity-related behaviors.
      Finally, they examined longitudinal changes in height, weight, body mass index (BMI), triceps
      skin fold thickness, and waist and hip circumferences in girls and boys 8 - 12 years of age,
      with respect to stages of pubertal development.