Physical Activity and Healthful Eating in Middle Schools

Abstract

Greaney et al. describe the problems of overweight and obesity, the efforts made to address this problem in school systems, and a rapid assessment procedure to determine the feasibility of implementing an interdisciplinary curriculum in a school setting. Regarding the last item, they discuss the need for researchers and practitioners to work together to develop multiple interventions that are collaborative, flexible, and effective. The current epidemic of inactivity and poor diet, along with the associated epidemic of obesity, is driven by multiple factors (societal, technological, industrial, commercial, financial), and each of these factors must be considered when dealing with the obesity problem. The Healthy Choices Collaborative Intervention used by Greaney et al. is designed to address these factors. It includes before- and after-school activities to expand school physical education, messages to dissuade youths from pursuing sedentary activities, including television viewing, and nutrition education to increase fruit and vegetable consumption. Community program implementation is more likely to be successful when community leaders are involved. Greaney et al. present the perceptions of key leaders who were previously involved in a school-based nutrition and physical activity program and who shared their perceptions regarding what is needed to facilitate the implementation and sustainability of the Healthy Choices Collaborative Intervention. Many ideas were presented by participants regarding critical elements needed for this program to be successful, including possessing resources, having a visible leader, and achieving buy-in from teachers, administrators, students, food-service personnel, parents, and the community at large. Greaney et al. discuss valuable information for program planners. When designing obesity interventions for youths, program planners are advised to consider characteristics of the priority population. The authors demonstrate that middle school youths as a group require specific attention and intervention. Nutrient needs, eating patterns, and physical activity patterns change markedly during the middle school years. For example, most children maintain adequate milk intake until about 9 years of age. After age 9, milk intake should generally be increased to meet nutrient needs, but most children do not do so. This problem is especially pronounced in preteen girls. As children age and begin to have more influence over their food intake decisions, the nutritional quality of their diets declines. Age transitions in food consumption patterns need to be addressed in the development of school-based obesity prevention programs so that appropriate behavioral targets for nutrition education can be written into the curriculum. Thus, nutrition education between middle and elementary school should vary based on higher nutrient needs and changes in behavioral mediators such as greater freedom of choice. The Teens Eating for Energy and Nutrition at School (TEENS) study revealed that positive intervention results were limited with middle school students. Investigators suggested that future research consider the use of more controlled efficacy studies in working with this age group. They also suggested that efforts to reach this group include use of peer leaders, more intensive teacher training, ongoing formative assessment, and the testing of more powerful environmental change intervention strategies. (1) In examining the target group issue, planners also need to consider that adolescent girls tend to be less active and less responsive to specific treatments than their male counterparts. (2) To reach middle school girls, interventions that provide desirable role models for diet and activity are suggested. One study demonstrated positive body mass index changes among middle school girls who received computer-based feedback combined with parental support. (3) Tailored interventions are suggested for specific age and sex. …