Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health.

OBJECTIVE To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grades 6 to 8. DESIGN Randomized, controlled field trial with 5 intervention and 5 control schools. Outcomes were assessed using preintervention (fall 1995) and follow-up measures (spring 1997), including prevalence, incidence, and remission of obesity. PARTICIPANTS A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities. INTERVENTION Students participated in a school-based interdisciplinary intervention over 2 school years. Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education. Sessions focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity. MAIN OUTCOME MEASURES Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles. Because schools were randomized, rather than students, the generalized estimating equation method was used to adjust for individual-level covariates under cluster randomization. RESULTS The prevalence of obesity among girls in intervention schools was reduced compared with controls, controlling for baseline obesity (odds ratio, 0.47; 95% confidence interval, 0.24-0.93; P = .03), with no differences found among boys. There was greater remission of obesity among intervention girls vs. control girls (odds ratio, 2.16; 95% confidence interval, 1.07-4.35; P = .04). The intervention reduced television hours among both girls and boys, and increased fruit and vegetable consumption and resulted in a smaller increment in total energy intake among girls. Reductions in television viewing predicted obesity change and mediated the intervention effect. Among girls, each hour of reduction in television viewing predicted reduced obesity prevalence (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; P = .02). CONCLUSION Planet Health decreased obesity among female students, indicating a promising school-based approach to reducing obesity among youth.

[1]  T. Lohman,et al.  Changes in the Body Composition of Children , 1987 .

[2]  C. Perry,et al.  School-based cardiovascular health promotion: the child and adolescent trial for cardiovascular health (CATCH). , 1990, The Journal of school health.

[3]  K. Flegal,et al.  Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. , 1995, Archives of pediatrics & adolescent medicine.

[4]  B. Gutin,et al.  Physical Activity in the Prevention of Childhood Obesity , 1993, Annals of the New York Academy of Sciences.

[5]  T. Robinson,et al.  Ethnic and Gender Differences in the Relationships between Television Viewing and Obesity, Physical Activity, and Dietary Fat Intake , 1995 .

[6]  Sally N. Clark,et al.  Meeting the Needs of Young Adolescents. , 1994 .

[7]  G. Schreiber,et al.  Energy intake and physical activity in relation to indexes of body fat: the National Heart, Lung, and Blood Institute Growth and Health Study. , 1994, The American journal of clinical nutrition.

[8]  S. Kelder,et al.  Community-wide youth exercise promotion: long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study. , 1993, The Journal of school health.

[9]  R. Heidel,et al.  Healthy People 2000: national health promotion and disease prevention objectives (excerpts). US Public Health Service. , 1991, Journal of allied health.

[10]  W. DeJong,et al.  The stigma of obesity: the consequences of naive assumptions concerning the causes of physical deviance. , 1980, Journal of health and social behavior.

[11]  A. Roche,et al.  Grading body fatness from limited anthropometric data. , 1981, The American journal of clinical nutrition.

[12]  James M. Tanner,et al.  Fetus into Man , 1978 .

[13]  W H Dietz,et al.  Inactivity, diet, and the fattening of America. , 1990, Journal of the American Dietetic Association.

[14]  W. Dietz,et al.  Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. , 1994, The American journal of clinical nutrition.

[15]  S. Gortmaker,et al.  Re: "Secular trends in body mass in the United States, 1960-1980". , 1990, American journal of epidemiology.

[16]  B. Shannon,et al.  Body fatness, television viewing and calorie-intake of a sample of pennsylvania sixth grade children , 1991 .

[17]  D A Revicki,et al.  Relationship between body mass indices and measures of body adiposity. , 1986, American journal of public health.

[18]  G. Rose.  Sick individuals and sick populations. , 2001, International journal of epidemiology.

[19]  B. H. Patterson,et al.  Fruit and Vegetable Intake in the United States: The Baseline Survey of the Five a Day for Better Health Program , 1995, American journal of health promotion : AJHP.

[20]  Michael P. Jones.  Indicator and stratification methods for missing explanatory variables in multiple linear regression , 1996 .

[21]  S. Kelder,et al.  Community-wide youth nutrition education: long-term outcomes of the Minnesota Heart Health Program. , 1995, Health education research.

[22]  G A Colditz,et al.  Racial/ethnic and gender differences in concern with weight and in bulimic behaviors among adolescents. , 1997, Obesity research.

[23]  C. Loria,et al.  Energy and macronutrient intakes of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-91. , 1994, Advance data.

[24]  B. Collins,et al.  Measuring dietary behaviors among adolescents. , 1993, Public health reports.

[25]  J. Richmond,et al.  Child health, nutrition and physical activity. , 1995 .

[26]  J. Cutler,et al.  Review of Behavioral Research for Cardiopulmonary Health: Emphasis on Youth, Gender, and Ethnicity , 1995 .

[27]  S. Gortmaker,et al.  Factors within the physical environment associated with childhood obesity. , 1984, The American journal of clinical nutrition.

[28]  C. Perry,et al.  The Child and Adolescent Trial for Cardiovascular Health (CATCH): Overview of the intervention program and evaluation methods , 1992 .

[29]  T. Robinson,et al.  Cardiovascular disease risk reduction for tenth graders. A multiple-factor school-based approach. , 1988, JAMA.

[30]  E. Rimm,et al.  Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals. , 1998 .

[31]  S. Pocock,et al.  Clinical Trials: A Practical Approach , 1984 .

[32]  G A Colditz,et al.  Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. , 1996, Archives of pediatrics & adolescent medicine.

[33]  D. Commerce.  Statistical abstract of the United States , 1978 .

[34]  R. Luepker,et al.  Teenage health teaching modules: impact of teacher training on implementation and student outcomes. , 1991, The Journal of school health.

[35]  G A Colditz,et al.  Validation of a youth/adolescent food frequency questionnaire. , 1997, Preventive medicine.

[36]  L. Epstein,et al.  Laboratory assessment of choice between exercise or sedentary behaviors. , 1993, Research quarterly for exercise and sport.

[37]  W. Willett,et al.  Interval estimates for correlation coefficients corrected for within-person variation: implications for study design and hypothesis testing. , 1988, American journal of epidemiology.

[38]  S. Daniels,et al.  The utility of body mass index as a measure of body fatness in children and adolescents: differences by race and gender. , 1997, Pediatrics.

[39]  Obert,et al.  PREDICTING OBESITY IN YOUNG ADULTHOOD FROM CHILDHOOD AND PARENTAL OBESITY , 2000 .

[40]  K Y Liang,et al.  Longitudinal data analysis for discrete and continuous outcomes. , 1986, Biometrics.

[41]  L. Epstein,et al.  Behavioral economic analysis of activity choice in obese children. , 1991, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[42]  Godfrey J. Ellis.  Television and the Family , 1983 .

[43]  L. Epstein,et al.  A behavioral economics analysis of food choice in humans , 1990, Appetite.

[44]  H. Taras,et al.  Advertised foods on children's television. , 1995, Archives of pediatrics & adolescent medicine.

[45]  A. Hickey,et al.  Children's behavior responses to TV food advertisements , 1974 .

[46]  T. Lohman,et al.  Anthropometric Standardization Reference Manual , 1988 .

[47]  W. Dietz,et al.  Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. , 1991, The American journal of clinical nutrition.

[48]  L. Bandini,et al.  Effect of sedentary activities on resting metabolic rate. , 1994, The American journal of clinical nutrition.

[49]  G. Forbes,et al.  Skinfold thickness and body fat in children. , 1970, Human biology.

[50]  S. Kelder,et al.  CATCH: Classroom Process Evaluation in a Multicenter Trial , 1994, Health education quarterly.

[51]  S. Kelder,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. , 1996, JAMA.

[52]  A. R. Frisancho.  Physical Status: The Use and Interpretation of Anthropometry , 1996, The American Journal of Clinical Nutrition.

[53]  L. Epstein,et al.  DataBase: Research and Evaluation Results , 1995, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[54]  S. Gortmaker,et al.  Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. , 1985, Pediatrics.

[55]  J F Sallis,et al.  Compendium of physical activities: classification of energy costs of human physical activities. , 1993, Medicine and science in sports and exercise.

[56]  T N Robinson,et al.  Self-induced vomiting and laxative and diuretic use among teenagers. Precursors of the binge-purge syndrome? , 1986, JAMA.

[57]  L. Epstein,et al.  Ten-year follow-up of behavioral, family-based treatment for obese children. , 1990, JAMA.

[58]  K. Resnicow.  School‐based Obesity Prevention , 1993, Annals of the New York Academy of Sciences.

[59]  C. Shear,et al.  Secular trends of obesity in early life: the Bogalusa Heart Study. , 1988, American journal of public health.

[60]  C. Bouchard,et al.  Validity of anthropometry in classifying youths as obese. , 1989, International journal of obesity.

[61]  W H Dietz,et al.  Increasing pediatric obesity in the United States. , 1987, American journal of diseases of children.

[62]  A. Bandura.  Social Foundations of Thought and Action , 1986 .

[63]  G A Colditz,et al.  Reproducibility and validity of a self-administered physical activity questionnaire. , 1994, International journal of epidemiology.

[64]  F P Rivara,et al.  Effectiveness of a violence prevention curriculum among children in elementary school. A randomized controlled trial. , 1997, JAMA.

[65]  H. Perkinson,et al.  The Unschooled Mind: How Children Think and How Schools Should Teach , 1993 .

[66]  M. Singer,et al.  Nutritional Epidemiology , 2020, Definitions.

[67]  G A Colditz,et al.  Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents. , 1995, Journal of the American Dietetic Association.

[68]  G. Burke,et al.  Relationship of changes in obesity to serum lipid and lipoprotein changes in childhood and adolescence. , 1985, JAMA.