Implementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial

Abstract

Introduction: Healthier school environments can benefit students, and school wellness policies may result in meaningful enhancements. Schools participating in federal child nutrition programs must implement wellness policies as mandated by law. The primary study objective is to assess effectiveness of implementing school-based nutrition and physical activity policies on student BMI trajectories. Study design: Cluster randomized trial using 2 × 2 factorial design. Setting/participants: Twelve randomly selected schools in an urban district. Students were followed for 3 years through middle school, fifth to eighth grades (2011-2015, n=595 students, 92.3% participation, 85.2% retention). Intervention: Specific to randomized condition, support was provided for implementation of nutrition policies (e.g., alternatives to food-based rewards/celebrations) and physical activity policies (e.g., opportunities for physical activity during/after school). Main outcome measures: Sex-/age-adjusted BMI percentile and BMI z-score; behavioral indicators. Data collected via standardized protocols. Results: Analyses followed intention-to-treat principles, with planned secondary analyses (conducted 2016-2018). Students at schools randomized to receive support for nutrition policy implementation had healthier BMI trajectories over time (F=3.20, p=0.02), with a greater magnitude over time and cumulatively significant effects 3 years post-intervention (β= −2.40, p=0.04). Overall, students at schools randomized to receive the nutrition intervention had an increase in BMI percentile of <1%, compared with students in other conditions, whereas BMI

Knowledge and Understanding of Type 1 Diabetes and Its Management among Saudi Children and Adolescents

“…Within schools, it is essential to implement policies that promote health through adopting healthy life style and disseminating health messages [18]. Culture was also found to have an effect in this study, two fathers expressed their levels of knowledge and involvement in their children's care differed.…”

Factors influencing academic participation of undergraduate students

“…Although every school in the country has a written policy but, several studies have found that strong written policies do not necessarily predict thorough implementation. So, University needs to collaborate with students to assist in the implementation and evaluation of school wellness policies after they have been written and approved [27].…”

Treatment of children and adolescents who are overweight or obese

“…It required annual body mass index (BMI) screenings for all public school students, elimination of elementary school students’ access to vending machines, and creation of physical education and nutrition standards via district physical activity and nutrition committees along with input from a Child Health Advisory committee. 91 , 92 A study published in 2018 assessing the effectiveness of this policy concluded that it was very unlikely that the Arkansas Act was having an impact on preventing adolescent overweight and obesity. 93 …”