Trends in health behavior and weight outcomes following enhanced afterschool programming participation

Abstract

Background The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities. Although recommended, schools have difficulty consistently implement evidence-based obesity programing. We report on the effectiveness of adding structured nutrition education and minimum physical activity (PA) requirements to standard middle school after-school programming. Methods Using a longitudinal pre-post study design, we evaluated program effectiveness at one year on target behaviors on students recruited during three consecutive school years (2016–2018). We used generalized linear (or logistic) mixed-effects modeling to determine: 1) impact on healthy weight and target healthy behavior attainment, and 2) whether target behavior improvement and weight change were associated with after-school program attendance. The seven target behaviors relate to eating healthy, physical activity, and sleep. Results Over the three years, a total of 76 students enrolled and completed one year of programming (62% Hispanic, 46% girls, 72% with BMI > 85th %ile, 49% with BMI > 95th %ile). Of students with BMI > 85th %ile, 44% maintained or decreased BMI Z-score. There were improvements (non-significant) in BMI Z-score and the adoption of four healthy eating behaviors: fruit, vegetables, sugar-free beverages, and unhealthy snack food. Students with higher after-school attendance (> 75%) had greater improvements (non-significant) in composite behavior scores, BMI Z-score, and in most target behaviors (5/7) than students with lower after-school attendance (< 75%). Sleep improvements were significantly associated with BMI Z-score decrease (Beta = − 0.05, 95% CI (− 0.1,-0.003), p = 0.038.) Conclusions Enhancement of existing after-school programming with structured nutrition education and minimum physical activity requirements demonstrates positive improvements in several health behaviors and weight outcomes. Adopting enhanced after-school programming increases access to health activities and may bring us closer to solving obesity in at-risk youth in impoverished communities. Trial registration ClinicalTrials.govidentifier (NCT number):NCT03565744. Registered 21 June 2018 – Retrospectively registered.

Ecological system theory and community participation to promote healthy food environments for obesity and non-communicable diseases prevention among school-age children

“…EST at the microsystem level, the results showed improvement in physical activity, exercise behaviors, knowledge about obesity and NCDs prevention among students. This finding corresponds with the findings of previous studies focused on promoting exercise in schoolage children (31) and programs focused on knowledge about food and nutrition combined with promoting afterschool exercise (32) . The findings indicate that promoting exercise at school is efficient in improving the overall physical fitness for students (31) .…”

Effects of a Healthy Habit Promotion Strategy on Colombian Schoolchildren

“…Their strategy reinforced healthy eating habits, good physical activity, and rest in the afterschool period. Nonetheless, their results vary from those achieved by the U4HK strategy in that they only show non-significant improvements in behavior towards food (17).…”

“…Some authors report the necessity to include the afterschool period in these health promotion activities. For instance, Rieder et al carried out a longitudinal three-year study with 76 predominantly Latino schoolchildren in the United States, with pre and post-intervention measurements (17). Their strategy reinforced healthy eating habits, good physical activity, and rest in the afterschool period.…”

Association between Olympic Games and children’s growth: evidence from China

“… 23 28 29 Moreover, the Games have increased the Olympic values education and improved the attention to physical training in Chinese schools, and a large number of primary and secondary schools have opened up their sports facilities to the public, 22 which may also increase the possibility and accessibility of exercise for children after school, alone or together with their families. School-based physical activities are proven beneficial to the obesity prevention or treatment for children with overweight, 30 and physical activities after school are also reported to result in positive improvements in children’s weight outcomes 31 to avoid underweight. Notably, previous studies indicated that Chinese boys had higher prevalence of obesity and were more likely to be satisfied with their physical activity level than girls, 32 which may be a potential explanation for the sex difference in the association between the BOG and obesity found in our study.…”

“…obesity prevention or treatment for children with overweight, 30 and physical activities after school are also reported to result in positive improvements in children's weight outcomes 31 to avoid underweight. Notably, previous studies indicated that Chinese boys had higher prevalence of obesity and were more likely to be satisfied with their physical activity level than girls, 32 which may be a potential explanation for the sex difference in the association between the BOG and obesity found in our study.…”