A School‐Based Program for Overweight and Obese Adolescents: A Randomized Controlled Trial

Abstract

BACKGROUND Given the dramatic increase in adolescent overweight and obesity, models are needed for implementing weight management treatment through readily accessible venues. We evaluated the acceptability and efficacy of a school-based intervention consisting of school nurse-delivered counseling and an afterschool exercise program in improving diet, activity, and body mass index (BMI) among overweight and obese adolescents. METHODS A pair-matched cluster-randomized controlled school-based trial was conducted in which 8 public high schools were randomized to either a 12-session school nurse-delivered cognitive-behavioral counseling intervention plus school-based after school exercise program, or 12-session nurse contact with weight management information (control). Overweight or obese adolescents (N = 126) completed anthropometric and behavioral assessments at baseline and 8-month follow-up. Main outcome measures included diet, activity, and BMI. Mixed effects regression models were conducted to examine differences at follow-up. RESULTS At follow-up, students in intervention compared with control schools were not different in BMI, percent body fat, and waist circumference. Students reported eating breakfast (adjusted mean difference 0.81 days; 95% confidence interval [CI] 0.11–1.52) on more days/week; there were no differences in other behaviors targeted by the intervention. CONCLUSIONS While a school-based intervention including counseling and access to an after-school exercise program is theoretically promising with public health potential, it was not effective in reducing BMI or key obesogenic behaviors. Our findings are important in highlighting that interventions targeted at the individual level are not likely to be sufficient in addressing the adolescent obesity epidemic without changes in social norms and the environment.

Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools

“…Such factors only intensify physiological, hormonal, and metabolic resistance to weight loss (Farias, Cuevas, & Rodriguez, 2011; Müller, Bosy-Westphal, & Heymsfield, 2010). Therefore, school-based obesity interventions can only be expected to have modest effects (Elbel, Corcoran, & Schwartz, 2016); meaningful reduction in obesity rates will require multifaceted societal change (Block & Roberto, 2014; Pbert et al, 2016). …”

“…However, school nurses have been only involved in a limited amount of school-based obesity interventions (Pbert et al, 2016; Schroeder, Travers, & Smaldone, 2016). No school nurse-led intervention for children with severe obesity has been previously implemented or evaluated (Schroeder et al, 2016).…”

Ecological Factors Affecting Obesity Among Middle School Students in South Korea

“…In addition, school‐based programs—designed to be completed with peers who positively and consistently support and encourage each other—should be developed to increase PA levels and decrease obesity rates among adolescents . Furthermore, a scenario where school nurses, in addition to providing individual health counseling and after‐school exercise programs at school, also facilitate peer group activity programs in the community, might be worth consideration …”

“…In addition, social support from classmates, as an interpersonal factor, is an important contributor to the psychosocial functioning of obese youth and to the peer health spillover effect, in a school context . Recently, it was observed that intervention programs at the individual level were not effective, without changes being made to the environment . In addition, social and environmental factors that lead to high‐fat, high‐calorie eating habits and decreased physical activities have been suggested as the main factors contributing to the increase of obesity rates .…”

“…7,8 Recently, it was observed that intervention programs at the individual level were not effective, without changes being made to the environment. 9 In addition, social and environmental factors that lead to high-fat, high-calorie eating habits and decreased physical activities have been suggested as the main factors contributing to the increase of obesity rates. 10,11 For example, a higher fat content in school lunches was significantly related to childhood obesity, and the number of fast food restaurants present within a walking distance from schools was associated with an increased body mass index (BMI), among American adolescents.…”