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School-Based Food Intervention Curbs Children's Weight Gain 4-7-08
Changing the eating and snacking environment in
grade schools cuts the rate at which kids become overweight in half, a study
found.
Two years after schools adopted a healthy nutrition intervention, just 7.5% of
students had become overweight compared with 14.9% in schools that did not have
the intervention, Gary Foster, Ph.D., of Temple University here, and colleagues,
reported in the April issue of Pediatrics.
The findings came from a study of 1,349 children (mean age 11.2 years) in grades
four through six at 10 Philadelphia schools. Five schools were randomly assigned
to the intervention and five served as controls.
"The increasing prevalence and serious consequences of childhood obesity have
pushed us to find ways to reach greater numbers of children. We focused on
school because children spend most of their lives there and eat at least one if
not two meals there," Dr. Foster said.
The multi-faceted intervention, known as the School Nutrition Policy Initiative,
was developed by a community-based group and was based on the Dietary Guidelines
for Americans.
In the intervention schools, soda was replaced with water, 100% fruit juice, and
low-fat milk. Snacks were capped at 7g total fat, 2g saturated fat, 360 mg
sodium, and 15g sugar per serving. Candy was eliminated from the school
premises.
Nutrition education was also added to the school program -- teachers got 10
hours of training and students received 50 hours over the course of the year.
Children were rewarded for healthy snacking and encouraged to save their
appetites for healthy meals. Nutritious snacks and drinks earned them raffle
tickets to win prizes.
Nutrition educators encouraged parents and children to purchase healthy snacks
and students were challenged to be more active and to eat more fruits and
vegetables.
At baseline, 40.7% of the children in all the schools were overweight or obese,
and nearly a quarter (23.8%) were obese. Students were assessed at baseline and
again after two years.
Of all the students, 50% or more were eligible for free or reduced-price meals,
53.7 were girls and nearly half were African American.
After two years, the unadjusted prevalence of overweight in intervention schools
decreased by 10.3% compared with a 25.9% increase in the control schools.
After controlling for gender, race, and baseline prevalence, the predicted odds
of overweight were 35% lower for the intervention group (OR 0.65, P<0.001).
The effect was even greater for black students who were 41% less likely than
untreated black children to be overweight after two years compared with 35% less
likely in the entire group.
This is important, the researchers said, given the increased rates of overweight
among black children.
As for sedentary behavior, after controlling for gender, race/ethnicity, age,
and baseline inactivity, inactivity was 4% lower in the intervention group than
in the control group (OR: 0.96, P<0.01) after two years.
On the other hand, the intervention had no effect at the upper end of the BMI
scale, that is, on the prevalence or remission of obesity. These children may
require targeted or clinic-based programs rather than untargeted approaches such
as the intervention used here, the researchers said.
In addition, despite the decreased weight gain for intervention children, the
researchers expressed concern that the 7.5% increase over two years suggests
that stronger or additional interventions are needed.
These may include additional environmental changes in schools (more physical
education classes or more aggressive nutrition policies) or changes in outside
environments, such as local corner stores or after-school feeding programs.
A further troubling observation, the investigators said, is that in the absence
of any intervention, 15% of the children who were not overweight in grades four
to six became overweight over the next two years.
Among those who were not obese, 6% became obese within two years, a trend with
significant public health implications.
Despite the randomized nature of this study, the investigators noted that the
small sample of 10 schools limited the ability to create identically equivalent
groups, so that the two groups may have differed on unmeasured variable.
These findings suggest that about 3 million U.S. children, ages 10 to 14, will
become overweight, and about 1.3 million will become obese over two years, the
researchers said.
Given the more than 7% increase in new overweight cases even in the intervention
schools, there is much room for improvement in the effect, dose, and range of
interventions, the researchers said, and those interventions should start even
earlier in a child's school career.