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

Jessica Rieder,Jee-Young Moon,Judy Wylie-Rosett,Joanna Joels,Elicia Johnson-Knox,Bailey Frohlich,Viswanathan Shankar,Paul Meissner,Shelby Davies

doi:10.1186/s12889-021-10700-4

Abstract

BackgroundThe 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.MethodsUsing 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.ResultsOver 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.)ConclusionsEnhancement 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 registrationClinicalTrials.govidentifier (NCT number):NCT03565744. Registered 21 June 2018 – Retrospectively registered.

Highlights

The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities
This paper reports on the effectiveness of adding structured nutrition education and a minimum requirement for physical activity to standard middle school-based after-school programming
A total of 76 students attended at least one clinic and one after-school session and engaged (55 with Body Mass Index (BMI) > 85th%ile) (Step 3) in the B’N Bronx Nutrition and Fitness Initiative for Teens (Fit) POWER program

Summary

Introduction

The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities. The most severe forms of obesity are increasing, especially among adolescents and non-Hispanic blacks [3]. Children with low socioeconomic status (SES) are 1.4 times more likely to be obese than higher SES children, and relative to higher SES Caucasian adolescents, low SES ethnic minority youth are less likely to live in neighborhoods supportive of physical activity [4, 5]. Despite the risk of health disparities and more severe forms of obesity for minority youth, in particular, there are limited effective preventive and treatment interventions for these youth [8,9,10]

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Results

Conclusion