Kids Dish

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.
Action Points

* Explain to interested patients that grade school children are at high risk of becoming overweight or obese if their school environment fails to bar unhealthy meals and snacks and slights nutrition education.

“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.