Two-Year BMI Outcomes From a School-Based Intervention for Nutrition and Exercise: A Randomized Trial

Abstract

OBJECTIVES: This study examined the long-term effects on BMI of a randomized controlled trial of Students for Nutrition and Exercise, a 5-week, middle school-based obesity prevention intervention combining school-wide environmental changes, encouragement to eat healthy school cafeteria foods, and peer-led education and marketing. METHODS:We randomly selected schools from the Los Angeles Unified School District and assigned 5 to the intervention group and 5 to a wait-list control group. Of the 4022 seventhgraders across schools, a total of 1368 students had their height and weight assessed at baseline and 2 years' postintervention. RESULTS:A multivariable linear regression was used to predict BMI percentile at ninth grade by using BMI percentile at seventh grade, school indicators, and sociodemographic characteristics (child gender, age, Latino race/ethnicity, US-born status, and National School Lunch Program eligibility [as a proxy for low-income status]). Although the Students for Nutrition and Exercise intervention did not exhibit significant effects on BMI percentile overall, intervention students who were classified as obese at baseline (in seventh grade) showed significant reductions in BMI percentile in ninth grade (b = -2.33 percentiles; SE, 0.83; P = .005) compared with control students. This outcome translated into ∼9 pounds (∼4.1 kg) lower expected body weight after 2 years for an obese student in the intervention school at the mean height and age of the sample at baseline. CONCLUSIONS:Multilevel school-based interventions can have long-term effects on BMI among students who are obese. Future research should examine the mechanisms by which schoolbased obesity interventions can affect BMI over time.a Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; b Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; c RAND Corporation, Santa Monica, California; d Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California; and e Community Partners and Medi-Cal Programs, Student Health and Human Services, Los Angeles Unifi ed School District, Los Angeles, California Dr Bogart conceptualized and designed the study, led the analysis plan and interpretation of the data, and drafted, reviewed, and revised the manuscript; Dr Elliott helped to design the study, led the analysis and interpretation of data, and reviewed and revised the manuscript; Dr Cowgill helped to design the program, helped to interpret data, and reviewed and revised the manuscript; Mr Klein analyzed and interpreted the data and drafted and revised the manuscript; Ms Hawes-Dawson led the data collection and reviewed and revised the manuscript; Dr Uyeda helped to conceptualize and design the study, helped to interpret data, and reviewed and revised the manuscript; Dr Schuster conceptualized and designed the study, analyzed and interpreted the data, and reviewed and revised the manuscript; and all authors approve...

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