Abstract
Objective
To evaluate Food, Health, & Choices, two 10-month interventions.
Design
Cluster-randomized, controlled study with 4 groups: curriculum, wellness, curriculum
plus wellness, and control.
Setting
Twenty elementary schools (5/group) in New York City.
Participants
Fifth-grade students (n = 1,159). At baseline, 44.6% were at the ≥85th body mass index
(BMI) percentile for age and 86% qualified for free or reduced-price lunch.
Intervention
Curriculum was 23 science lessons based on social cognitive and self-determination
theories, replacing 2 mandated units. Wellness was classroom food policy and physical
activity bouts of Dance Breaks.
Main Outcome Measures
For obesity, age- and sex-specific BMI percentiles were used (anthropometric measures).
The researchers also employed 6 energy balance-related behaviors and 8 theory-based
determinants of behavior change (by questionnaire).
Analysis
Pairwise adjusted odds in hierarchical logistic regression models were determined
for >85th BMI percentile. Behaviors and theory-based determinants were examined in
a 2-level hierarchical linear model with a 2 × 2 design for intervention effects and
interactions.
Results
Obesity showed no change. For behaviors, there was a negative curriculum intervention
change in physical activity (P = .04). The wellness intervention resulted in positive changes for sweetened beverages
frequency (P = .05) and size (P = .006); processed packaged snacks size (P = .01); candy frequency (P = .04); baked good frequency (P = .05); and fast food frequency (P = .003), size (P = .01), and combo meals (P = .002). Theory-based determinants demonstrated no change.
Conclusions and Implications
The findings of the lack of a decrease in obesity, behavior changes only for the wellness
intervention, and no changes in theory-based determinants warrant further research.
Key Words
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References
- Solving the Problem of Childhood Obesity Within a Generation: White House Task Force Report on Childhood Obesity Report to the President.Whitehouse Task Force, Washington, DC2010
- School gardens enhance academic performance and dietary outcomes in children.J Sch Health. 2015; 85: 508-518
- The Whole School, Whole Community, Whole Child Model: a new approach for improving educational attainment and healthy development for students.J Sch Health. 2015; 85: 729-739
- What childhood obesity prevention programmes work? A systematic review and meta-analysis.Obes Rev. 2015; 16: 547-565
- A multivariate analysis of federally mandated school wellness policies on adolescent obesity.J Adolesc Health. 2011; 49: 363-370
- School District Wellness Policies: Evaluating Progress and Potential for Improving Children's Health Eight Years After the Federal Mandate. School Years 2006–07 Through 2013–2014. 4. Bridging the Gap Program and the National Wellness Policy StudyInstitute for Health Research and PolicyUniversity of Illinois at Chicago, Chicago, IL2016
- A policy-based school intervention to prevent overweight and obesity.Pediatrics. 2008; 121: e794-e804
- Cluster randomised trial of a school-community child health promotion and obesity prevention intervention findings from the evaluation of Fun ’n Healthy in Moreland!.BMC Public Health. 2017; 18: 92
- Intraclass correlation coefficients for obesity indicators and energy balance related behaviors among New York City public elementary schools.Health Educ Behav. 2016; 43: 172-181
- Nutrition Education: Linking Research Theory and Practice.3rd ed. Jones and Bartlett, Burlington, MA2016
- Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.Pediatrics. 2007; 120: 164-192
- Dietary Guidelines for Americans, 2010.7th ed. US Government Printing Office, Washington, DC2010
- Are current health behavioral change models helpful in guiding prevention of weight gain efforts.Obes Res. 2003; 11: 23S-43S
- Byrd-Bredbenner C. Determinants of fruit and vegetable intake in low-income children and adolescents.Nutr Rev. 2014; 72: 575-590
- Improving nutrition education in U.S. elementary schools: challenges and opportunities.J Educ Pract. 2015; 6: 41-50
- A mixed methods comparison of classroom context during Food, Health & Choices, a childhood obesity prevention intervention.J Sch Health. 2017; 87: 811-822
- The impact of a population-level school food and nutrition policy on dietary intake and body weights of Canadian children.Prev Med. 2013; 57: 934-940
- Ten years of TAKE 10!: integrating physical activity with academic concepts in elementary school classrooms.Prev Med. 2011; 52: S43-S50
- Impact of three years of classroom physical activity bouts on time-on-task behavior.Med Sci Sports Exerc. 2017; 49: 2343-2350
- Evaluating the relationships among teacher characteristics, implementation factors, and student outcomes of children participating in an experiential school-based nutrition program.Pedagogy Health Promot. 2016; 2: 256-265
- Efficacy, intent to teach, andimplementation of nutrition education increases after training for health educators.J Health Educ. 2011; 42: 181-190
US Department of Agriculture. Choose MyPlate. https://www.choosemyplate.gov/. Accessed January 15, 2019.
- Adolescents demonstrate improvement in obesity risk behaviors after completion of Choice, Control & Change (C3), a curriculum addressing personal agency and autonomous motivation.J Am Diet Assoc. 2010; 110: 1830-1839
- “Creature-101”: a serious game to promote energy balance-related behaviors among middle school adolescents.Games Health J. 2013; 2: 280-290
- Associations among measures of energy balance related behaviors and psychosocial determinants in urban upper elementary school children.Appetite. 2017; 108: 171-182
- Validity and reliability of behavior and theory-based psychosocial determinants measures, using audience response system technology in urbanupper-elementary schoolchildren.J Nutr Educ Behav. 2016; 48: 437-452
Centers for Disease Control and Prevention. Clinical Growth Charts. https://www.cdc.gov/growthcharts/clinical_charts.htm. Accessed January 15, 2019.
- Testing an integrated model of program implementation: the Food, Health & Choices school-based childhood obesity prevention intervention process evaluation.Prev Sci. 2017; 18: 71-82
- Factors influencing efficacy of nutrition education interventions: a systematic review.J Nutr Educ Behav. 2017; 49: 142-165
- Hirst K. School-based intervention for diabetes reduction (HEALTHY Study Group).N Engl J Med. 2010; 363: 443-453
- Interventions for preventing obesity in children.Cochrane Database Syst Rev. 2011; 12CD001871
- Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis.Int J Obes (Lond). 2008; 32: 1780-1789
- Outcomes of a field trial to improve children's dietary patterns and physical activity: the Child and Adolescent Trial for Cardiovascular Health (CATCH).JAMA. 1996; 275: 768-776
- Project FIT: a school, community, and social marketing intervention improves healthy eating among low-income elementary school children.J Community Health. 2015; 40: 815-826
- Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y.Am J Clin Nutr. 2012; 96: 889-901
- Navigating the obesogenic environment: how psychological sensitivity to the food environment and self-regulatory competence are associated with adolescent unhealthy snacking.Eat Behav. 2015; 17: 19-22
- An associative account of how the obesogenic environment biases adolescents’ food choices.Appetite. 2016; 96: 560-571
- Behavior change is not one size fits all: psychosocial phenotypes of childhood obesity prevention intervention participants.Transl Behav Med. 2018; 8: 799-807
Article info
Publication history
Published online: February 14, 2019
Accepted:
December 3,
2018
Footnotes
Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.
Identification
Copyright
© 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- CorrigendumJournal of Nutrition Education and BehaviorVol. 52Issue 6
- PreviewThe April 2019 issue of the Journal of Nutrition Education and Behavior carried a Research Article titled “Food, Health, & Choices: Curriculum and Wellness Interventions to Decrease Childhood Obesity in Fifth-Graders” (J Nutr Educ Behav. 2019;51(4):440-455; https://doi.org/10.1016/j.jneb.2018.12.001 ). There were 2 errors regarding the body mass index percentile. The second sentence of the Study Design section on page 441 should read, “The primary outcome was reduced prevalence of body mass index (BMI) ≥85th percentile for gender and age.” The first sentence of the evaluation section on page 448 should read, “Primary outcomes were a decrease in the percentage of students who had an age- and gender-specific ≥85th percentile BMI.” The percentile was incorrectly described as “>85th” and “<85th,” respectively.
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