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Using routinely collected growth data to assess a school-based obesity prevention strategy

International Journal of Obesity volume 37, pages 79–85 (2013)Cite this article

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Abstract

Background:

Studies of school-based anti-obesity interventions have yielded inconsistent results. Using growth screening data from a school administrative database, we re-evaluated an obesity prevention strategy that was previously reported to have a beneficial effect on weight status of a sample of students in grades 5–7.

Methods:

Ten K-8 schools (five control and five intervention) participated in a 2-year cluster-randomized trial of a multi-component nutrition education intervention. We obtained student height and weight data for 6 consecutive school years and imputed missing baseline and follow-up measurements (53% and 55%, respectively) and defined the target population based on the intent-to-treat principle. We analyzed changes in body mass index (BMI) Z-scores via mixed-effects linear regression and in the prevalence of overweight/obesity via conditional logistic regression. We also assessed incidence and remission of overweight/obesity and long-term effects.

Results:

We analyzed data for 8186 (96%) K-8 students in the 10 schools (4511 in intervention; 3675 in control). From baseline to the end of the intervention period, mean increases in BMI Z-score were 0.10 and 0.09 in the control and intervention groups, respectively (P=0.671). The prevalence of overweight/obesity increased by 3% in both groups (P=0.926). There was no significant intervention effect on the incidence or remission of overweight/obesity. Among 5469 students who attended study schools during both years of the intervention, there was no significant intervention effect. Furthermore, there was no long-term effect among students with up to 2 years of data beyond the end of the intervention.

Conclusion:

Using routinely collected data for the entire target population, we failed to confirm earlier findings of an intervention effect observed in a subset of students in grades 5–7. Volunteer bias in the prior evaluation and/or measurement error in the routinely collected data are potential reasons for the discrepant findings.

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References

  1. Wake M, Canterford L, Patton GC, Hesketh K, Hardy P, Williams J et al. Comorbidities of overweight/obesity experienced in adolescence: longitudinal study. Arch Dis Child 2010; 95: 162–168.

    Article  Google Scholar 

  2. Bell LM, Byrne S, Thompson A, Ratnam N, Blair E, Bulsara M et al. Increasing body mass index z-score is continuously associated with complications of overweight in children, even in the healthy weight range. J Clin Endocrinol Metab 2007; 92: 517–522.

    Article  CAS  Google Scholar 

  3. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS . The relation of overweight to cardiovascular risk factors among children and adolescents: the bogalusa heart study. Pediatrics 1999; 103: 1175–1182.

    Article  CAS  Google Scholar 

  4. Hampl SE, Carroll CA, Simon SD, Sharma V . Resource utilization and expenditures for overweight and obese children. Arch Pediatr Adolesc Med 2007; 161: 11–14.

    Article  Google Scholar 

  5. Estabrooks PA, Shetterly S . The prevalence and health care use of overweight children in an integrated health care system. Arch Pediatr Adolesc Med 2007; 161: 222–227.

    Article  Google Scholar 

  6. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB . Years of life lost due to obesity. JAMA 2003; 289: 187–193.

    Article  Google Scholar 

  7. Narayan KMV, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF . Lifetime risk for diabetes mellitus in the united states. JAMA 2003; 290: 1884–1890.

    Article  CAS  Google Scholar 

  8. Kvaavik E, Tell GS, Klepp KI . Predictors and tracking of body mass index from adolescence into adulthood: follow-up of 18 to 20 years in the Oslo Youth Study. Arch Pediatr Adolesc Med 2003; 157: 1212–1218.

    Article  Google Scholar 

  9. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH . Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 337: 869–873.

    Article  CAS  Google Scholar 

  10. Bao W, Srinivasan SR, Wattigney WA, Berenson GS . Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood. The Bogalusa Heart Study. Arch Intern Med 1994; 154: 1842–1847.

    Article  CAS  Google Scholar 

  11. Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011; 365: 1876–1885.

    Article  CAS  Google Scholar 

  12. Yeung EH, Zhang C, Louis GM, Willett WC, Hu FB . Childhood size and life course weight characteristics in association with the risk of incident type 2 diabetes. Diabetes Care 2010; 33: 1364–1369.

    Article  Google Scholar 

  13. Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999; 153: 409–418.

    Article  CAS  Google Scholar 

  14. Berenson GS, Arbeit ML, Hunter SM, Johnson CC, Nicklas TA . Cardiovascular health promotion for elementary school children. The heart smart program. Ann N Y Acad Sci 1991; 623: 299–313.

    Article  CAS  Google Scholar 

  15. Katz DL, O'Connell M, Njike VY, Yeh MC, Nawaz H . Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes 2008; 32: 1780–1789.

    Article  CAS  Google Scholar 

  16. Kropski JA, Keckley PH, Jensen GL . School-based obesity prevention programs: An evidence-based review. Obesity 2008; 16: 1009–1018.

    Article  Google Scholar 

  17. Nader PR, Stone EJ, Lytle LA, Perry CL, Osganian SK, Kelder S et al. Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and adolescent trial for cardiovascular health. Arch Pediatr Adolesc Med 1999; 153: 695–704.

    Article  CAS  Google Scholar 

  18. Katz DL . School-based interventions for health promotion and weight control: not just waiting on the world to change. Annu Rev Public Health 2009; 30: 253–272.

    Article  CAS  Google Scholar 

  19. Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T et al. Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr 2003; 78: 1030–1038.

    Article  CAS  Google Scholar 

  20. Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ 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. JAMA 1996; 275: 768–776.

    Article  CAS  Google Scholar 

  21. Sallis JF, McKenzie TL, Alcaraz JE, Kolody B, Hovell MF, Nader PR . Project SPARK. Effects of physical education on adiposity in children. Ann N Y Acad Sci 1993; 699: 127–136.

    Article  CAS  Google Scholar 

  22. Sallis JF, McKenzie TL, Conway TL, Elder JP, Prochaska JJ, Brown M et al. Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools. Am J Prev Med 2003; 24: 209–217.

    Article  Google Scholar 

  23. Foster GD, Linder B, Baranowski T, Cooper DM, Goldberg L, Harrell JS et al. A school-based intervention for diabetes risk reduction. N Engl J Med 2010; 363: 443–453.

    Article  CAS  Google Scholar 

  24. Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J et al. A policy-based school intervention to prevent overweight and obesity. Pediatrics 2008; 121: e794–e802.

    Article  Google Scholar 

  25. Gortmaker SL, Cheung LW, Peterson KE, Chomitz G, Cradle JH, Dart H et al. Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving. Arch Pediatr Adolesc Med 1999; 153: 975–983.

    Article  CAS  Google Scholar 

  26. Economos CD, Hyatt RR, Goldberg JP, Must A, Naumova EN, Collins JJ et al. A community intervention reduces BMI z-score in children: shape up somerville first year results. Obesity 2007; 15: 1325–1336.

    Article  Google Scholar 

  27. Comprehensive School Nutrition Policy Task Force. Comprehensive School Nutrition Policy. Philadelphia, PA, 2002.

  28. Centers for Disease Control and Prevention. CDC Growth Charts. CDC: Atlanta, GA.

  29. Centers for Disease Control and Prevention. A SAS Program for the CDC Growth Charts. CDC: Atlanta, GA.

  30. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z et al2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11 2002; 1–18.

  31. Rubin DB . Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons, Inc.: New York, 1987.

    Book  Google Scholar 

  32. Schafer JL . Analysis Of Incomplete Multivariate Data. Chapman & Hall: London, UK, 1997.

    Book  Google Scholar 

Download references

Acknowledgements

This work was supported by a grant from The Thrasher Research Fund. We also acknowledge the help and cooperation of the School District of Philadelphia and of Dr Gary D Foster, who provided key information about the intervention. The study was approved by the Institutional Review Board of Thomas Jefferson University.

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Authors and Affiliations

  1. Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA, USA

    E B Rappaport

  2. Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA, USA

    C Daskalakis & J A Sendecki

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  1. E B Rappaport
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  2. C Daskalakis
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Correspondence to E B Rappaport.

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Rappaport, E., Daskalakis, C. & Sendecki, J. Using routinely collected growth data to assess a school-based obesity prevention strategy. Int J Obes 37, 79–85 (2013). https://doi.org/10.1038/ijo.2012.126

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