School-based Obesity Interventions Research Articles

Design and Usability Testing of a Web-Based Intervention Module for Obesity: CoPT Nutri Trail

INTRODUCTION: Online interventions have emerged as innovative solutions to address health issues, notably obesity, while minimizing the necessity for in-person interactions during the recent COVID-19 pandemic. There is urgency in designing and developing an appropriate online intervention module within a web-based application. This study aims to describe the design process and usability of the online Canteen Operators, Parents, and Teachers (CoPT Nutri Trail) module for an upcoming school-based obesity intervention. MATERIALS AND METHODS: The design methodology consists of four phases: content development, design, web app development, and usability testing. The web application was designed to personalize usage for teachers, parents, and canteen operators to foster healthy environments for children. Thirteen experts, including teachers, nutritionists, and IT professionals, participated in the usability testing. RESULTS: All experts agreed that the design of the web application met the requirements of target users, requiring slight improvements in graphic design, language, and information elements. The web application tool was found acceptable, as the usability of alpha scores for all interface elements ranged from 68.2% to 86.6%, falling between good and very good scores. The content validation indices indicate good levels of validity (ranging from 0.83 to 1.00). CONCLUSION: The CoPT Nutri Trail web application is ready to be launched as a school-based intervention for obesity.

Recruitment and reach in a school-based pediatric obesity intervention trial in rural areas.

The purpose of this study is to evaluate two recruitment strategies on schools and participant participation rates and representativeness (reach) within a pediatric obesity treatment trial tailored for families who live in rural areas. Recruitment of schools was evaluated based on their progress toward enrolling participants. Recruitment and reach of participants were evaluated using (1) participation rates and (2) representativeness of demographics and weight status of participants compared to eligible participants (who did not consent and enroll) and all students (regardless of eligibility). School recruitment, as well as participant recruitment and reach, were evaluated across recruitment methods comparing opt-in (i.e., caregivers agreed to allow their child to be screened for eligibility) vs. screen-first (i.e., all children screened for eligibility). Of the 395 schools contacted, 34 schools (8.6%) expressed initial interest; of these, 27 (79%) proceeded to recruit participants, and 18 (53%) ultimately participated in the program. Of schools who initiated recruitment, 75% of schools using the opt-in method and 60% of schools using the screen-first method continued participation and were able to recruit a sufficient number of participants. The average participation rate (number of enrolled individuals divided by those who were eligible) from all 18 schools was 21.6%. This percentage was higher in schools using the screen-first method (average of 29.7%) compared to schools using the opt-in method (13.5%). Study participants were representative of the student population based on sex (female), race (White), and eligibility for free and reduced-price lunch. Study participants had higher body mass index (BMI) metrics (BMI, BMIz, and BMI%) than eligible non-participants. Schools using the opt-in recruitment were more likely to enroll at least 5 families and administer the intervention. However, the participation rate was higher in screen-first schools. The overall study sample was representative of the school demographics.

Perceived Barriers to Digitising School-Based Obesity Intervention: An Exploratory Study.

BackgroundSchools serve as a focal point in which to engage students and school communities, including teachers, parents and other healthcare providers (e.g. nutritionists), in implementing obesity interventions. Bringing them together is beneficial to ensuring healthy eating among schoolchildren and to creating healthy school environments. However, there are barriers and success factors related to the implementation of such an intervention. Therefore, this study aimed to explore the barriers and success factors to school-based obesity interventions to improve obesity implementation.MethodsAn exploratory case study with multiple units of analysis was conducted, including interviews, document analyses and a survey. The interview sessions involved six participants, including teachers and nutritionists. The survey was conducted among 121 participants involving 30 teachers, 78 parents and 13 school canteen operators. Pattern-matching techniques were employed to formulate the results.ResultsThe barriers consisted of the school system, parental awareness, staff availability, and children’s compliance. The success factors included the teachers’ role, the nutritional approach used, compliance with the healthy school canteen guidelines, and strong collaboration with the Parent-Teacher Association (PTA) and other agencies.ConclusionIt is necessary to digitise an obesity intervention module with some improvements, including strengthening the broader school community’s role and integrating nutrition education with technology to improve implementation.

Exploratory Decision Trees to Predict Obesity Intervention Response among Hispanic American Youth.

Introduction: Individual variability in weight-related outcomes from obesity intervention is widely acknowledged, yet infrequently addressed. This study takes a first step to address individual variation by determining characteristics that distinguish responsive (improvements in BMI) from unresponsive individuals. Methods: Classification regression tree (CRT) analysis grouped 185 low-income, Hispanic American middle school students who received a school-based obesity intervention. Predictors included baseline age, gender, standardized BMI, health-related quality of life (PedsQL), minutes of moderate-vigorous physical activity (MVPA; accelerometry), energy consumption, and dietary quality (Block Kids 2004 Food Frequency Questionnaire). Response regarding weight-related outcomes to the intervention was defined according to the American Academy of Pediatrics (AAP) guidelines. Six trees were produced, one for 3- and one for 6-month outcomes among all participants, participants with healthy weight status, and participants with overweight/obesity at baseline. Results: The AAP criteria for response were met by 57.3% and 35.1% of participants at 3 and 6 months, respectively. CRT produced six unique trees. Notably, minutes of MVPA appeared twice (the first time at the top of the tree) in most 3-month models. In addition, response at 3 months consistently appeared as the first variable in all the 6-month models. Conclusions: Overall, the number of distinct pathways and the repeated appearance of the same variable within a pathway illustrate the complex, interactive nature of factors predicting an intervention response. Initially unresponsive individuals were unlikely to respond later in the intervention. More complex modeling is needed to better understand how to best predict who will be responsive to interventions.

Scoping Review of School-Based Obesity Interventions among Children and Adolescents in Arabic Speaking Countries

BACKGROUND: Childhood and adolescent obesity globally presents a huge public health problem and the dramatic increase in its prevalence and associated poor health outcomes pose serious concerns among Arabic-speaking countries.
 
 AIM: This scoping review seeks to identify the characteristics and assess the effectiveness of school-based health promotion interventions on prevention or reduction of overweight/obesity among children and adolescents. This review further describes the implementation and evaluation of nutrition and physical activity interventions and their measured health outcomes for schools in Arabic speaking countries. 
 
 METHODS: We searched 10 electronic databases (PubMed MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), ERIC, EMBASE, ProQuest, EBSCO Host and Global Health) from 2010 to 2020 for studies evaluating school-based health promotion interventions on obesity or overweight among children and adolescents in Arab speaking countries. Sixteen studies met the inclusion criteria for this review and narrative synthesis was conducted. 
 
 RESULTS: The 16 articles reported on eight discretely different interventions which were largely school-based and examined physical activity and/or nutritional changes as well as changes in knowledge and attitude in regard to physical activity and nutrition. 
 
 CONCLUSION: Our review demonstrates an inconclusive and mixed effect of behavioural and physical activity intervention on prevention or reduction of obesity and/or overweight. While the strengths and limitations of the various interventions may have influenced the outcomes, long-term school-based interventions with rigorous methodological and theoretical frameworks are necessary to assess the true impact of these interventions on childhood and adolescent obesity in Arab speaking countries.

School-based obesity interventions in the metropolitan area of Rio De Janeiro, Brazil: pooled analysis from five randomised studies.

School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.

The Role of Early and Later Response on Overall Outcomes in School-Based Obesity Intervention.

Early response to obesity intervention consistently predicts long-term BMI reductions. However, little is known about how changes in weight at other times in an intervention may impact long-term outcomes. This study examined the relationship between weight-related changes that occurred early and later during an intervention and the association between these changes with overall outcomes. A secondary analysis of a school-based obesity intervention with replicated efficacy among Hispanic middle school students was conducted (n = 174). Linear regression models were developed in which first and second semester changes in BMI represented as a percentage of the 95th BMI percentile (%BMIp95) were separately used to predict overall %BMIp95 outcomes. First semester changes in %BMIp95 were used to predict subsequent %BMIp95 change (i.e., second semester). Changes in %BMIp95 during both the first and second semesters were independently associated with overall changes from baseline (e.g., at 24 months: first semester, β = 0.59, P < 0.01; second semester, β = 1.02, P < 0.001). First semester %BMIp95 change was not associated with second semester change (β = -0.07, P = 0.32). Change at any point during the intervention was predictive of overall weight outcomes. Additional research is needed to understand patterns of weight changes throughout interventions to better understand long-term outcomes.

Cost\u2013utility and cost\u2013benefit analyses of school-based obesity prevention program

BackgroundEconomic evaluation of school-based obesity interventions could provide support for public health decision of obesity prevention. This study is to perform cost–utility and cost–benefit assessment of three school-based childhood obesity interventions including nutrition education intervention (NE), physical activity intervention (PA) and comprehensive intervention (both NE and PA, CNP) with secondary data analysis of one randomized controlled trial.MethodsThe standard cost-effectiveness analysis methods were employed from a societal perspective to the health outcome and costs that are attributable to the intervention. NE, PA and CNP were carried out separately for 2 semesters for childhood obesity interventions in primary schools. The additional quality-adjusted life years (QALYs) resulting from the interventions were measured as the health outcome. A cost–utility ratio (CUR) and A cost–benefit ratio (CBR) was calculated as the ratio of implementation costs to the total medical and productivity loss costs averted by the interventions.ResultsThe CUR and CBR were ¥11,505.9 ($1646.0) per QALY and ¥1.2 benefit per ¥1 cost respectively, and the net saving was ¥73,659.6 ($10,537.9). The CUR and CBR for nutrition education and physical activity interventions were ¥21,316.4 ($3049.6) per QALY and ¥0.7 benefit per ¥1 cost, ¥28,417.1 ($4065.4) per QALY and ¥0.4 benefit per ¥1 cost, respectively (in 2019 RMB). Compared with PA intervention, the ICERs were ¥10,335.2 ($1478.6) and 4626.3 ($661.8) for CNP and NE respectively. The CBR was ¥1.2, 0.7, and 0.4 benefits per ¥1 cost for CNP, NE, and PA interventions, respectively. Net estimated savings were achieved only through CNP intervention, amounting to ¥73,659.6 ($10,537.9).ConclusionsComprehensive school-based obesity intervention is a beneficial investment that is both cost-effective and cost saving. Compared with PA intervention, both CNP and NE intervention were more cost-effective.

Feasibility and Efficacy of “Parent-Dietitian Conferences” to Increase Parental Involvement in School-based Obesity Intervention Among Adolescents

Feasibility and Efficacy of “Parent-Dietitian Conferences” to Increase Parental Involvement in School-based Obesity Intervention Among Adolescents

Measuring Determinants of Health for a School-based Obesity Intervention

Measuring Determinants of Health for a School-based Obesity Intervention

The associations of specific school- and individual-level characteristics with obesity among primary school children in Beijing, China.

We aimed to investigate the associations between school-level characteristics and obesity among Chinese primary school children with consideration of individual-level characteristics. This cross-sectional study was conducted in 2015/2016. School-level characteristics were assessed using an interviewer-administered school questionnaire, and a 'school-based obesity prevention index' was further developed. Individual-level characteristics were collected by self-administered questionnaires. Objectively measured height and weight of students were collected, and obesity status was classified according to the International Obesity Task Force criteria for Asian children. Generalised linear mixed models were used to estimate the associations among the school- and individual-level characteristics and obesity of students. Thirty-seven primary schools from an urban and a rural district of Beijing, China. School staffs, 2201 students and their parents. The school-based obesity prevention index involved the number of health professionals, availability of students' health records, monitoring students' nutrition status, frequency of health education activities, reporting achievements of obesity prevention activities to parents, duration of physical activity during school time and availability of playground equipment. The prevalence of obesity was lower in schools with the higher index value compared with that in schools with the lower index value (OR 0·56; 95 % CI 0·40, 0·79). Some individual-level characteristics were negatively associated with childhood obesity: liking sports, duration of screen time ≤2 h/d, perceived lower eating speed, parental non-overweight/obesity. Irrespective of individual-level characteristics, the specific school-level characteristics had a cumulative effect on obesity among Chinese primary school children. Further school-based obesity intervention should consider these characteristics simultaneously.

Dietary Practices and Meal Patterns among Overweight and Obese School Children in Malaysia: Baseline Data from a School-Based Intervention Study

ABSTRACT This study aimed to determine dietary practices and meal patterns among Malaysian overweight and obese school children at baseline. This study was part of a school-based obesity intervention study, My Body is Fit and Fabulous at School (MyBFF@school). It involved 1045 primary and 1041 secondary overweight and obese school children from a randomly selected 23 out of 1196 primary and 15 out of 416 secondary government schools in central Peninsular Malaysia. The results showed a significantly higher of adequate intake (4–8 servings/day) of cereals and grains among primary (54.7%) than secondary school children (48.2%). About 28.2% of primary and 32.6% of secondary school children had consumed adequate fruit (2 servings/day), while a very low percentage of both primary (5.0%) and secondary (3.6%) school children consumed adequate vegetables (3 servings/day). As for the meal patterns, school children in both primary and secondary were not taking breakfast regularly (mean±SD for primary: 3.16 ± 2.61 days/week vs secondary: 2.97 ± 2.52 days/week). There was also a significantly higher mean frequency of primary school children brought plain water to school than the secondary school children. In conclusion, urgent actions to address improper dietary practices and meal patterns of overweight and obese school children in Malaysia are warranted.

Frequency of school-based intervention needed to improve weight outcomes of Mexican-American adolescents with overweight or obesity: a randomized controlled trial.

Efficacious school-based interventions among ethnic minority youth are often intensive and difficult to disseminate. This parallel, open-label-randomized controlled trial aimed to compare changes in adolescent-standardized body mass index (zBMI) from a school-based obesity intervention given 0, 1, 3, or 5 days a week. Mexican-American youth (n = 243) with overweight or obesity were recruited from a Houston school district and randomized to receive an obesity intervention with established efficacy 0 (control), 1, 3, or 5 d/wk (respectively, equating to 0, 40, 120, or 200 min of contact each week). In each condition, 80% of intervention time was allocated to physical activity and 20% to nutrition, with behavioural modification overlaid throughout. zBMI was calculated from directly measured height and weight. A linear mixed model evaluated differences in zBMI over time between conditions. Participants were 12.02 ± 0.57 years old with a zBMI of 1.80 ± 0.46 at baseline. Among those with complete data at 1 year (n = 203), a significant condition by time interaction was indicated (F = 9.42, P < .001). Those who received the intervention 3 or 5 d/wk had significantly greater decreases in zBMI than control (respectively, -0.19 zBMI units/y; 95% CI, -0.28 to -0.11; and -0.18 zBMI units/y; 95% CI, -0.27 to -0.10, both P < .001). No differences were found between 3 and 5 d/wk (95% CI, -0.09-0.08, P = .87). The intervention provided 3 d/wk resulted in similar zBMI improvements as the intervention provided 5 d/wk. This information can be used to develop scalable school-based obesity interventions.

The Incidence of Obesity, Assessed as Adiposity, Is Reduced After 1 Year in Primary Schoolchildren by the POIBA Intervention

Childhood obesity is becoming a serious problem, and prevention programs are needed. The purpose of this study was to evaluate, after 1 y, the effectiveness of a multicomponent, school-based obesity intervention program. This intervention, conducted in Barcelona, Spain, was a quasi-experimental obesity primary prevention intervention targeting schoolchildren aged 9-10 y. Participants were assigned to an intervention group (IG) (1464 students) or to a comparison group (CG) (1609 students). The intervention consisted of a 9-session classroom program, 6 weekly sessions of physical education and out-of-school physical activity, and a workshop for families. It lasted from October 2011 to May 2012. Data obtained at baseline (spring 2011) and follow-up (spring 2012) included information on nutrition and physical activity, through 2 self-reported questionnaires, and measurement of weight, height, triceps skinfold thickness, and waist circumference. The cumulative incidence rate (CIR) of obesity was calculated from triceps skinfold measures. A multilevel logistic regression model was fitted to determine the association between the intervention and the CIR of obesity. The effect size of the program was estimated with Cohen's criteria. The overall prevalence of obesity at baseline was 12.7%. At the 12-mo follow-up, the incidence of obesity was 7.8% in the IG compared with 11.4% in the CG (P<0.005), representing 31% fewer new cases of obesity in the IG. The Cohen's d effect size of the program was 0.33. In the multilevel analysis, there was a protective effect of the intervention on the CIR of obesity at 12 mo (OR: 0.7; 95% CI: 0.5, 0.9) (P=0.009). The first Prevención de la Obesidad Infantil en Barcelona (Childhood Obesity Prevention in Barcelona) (POIBA) intervention, targeting children aged 9-10 y, reduced the incidence of obesity as measured by adiposity. The intervention could prevent 1 in 3 new cases of childhood obesity in this age range.

Development of the PEA-PODS (Perceptions of the Environment and Patterns of Diet at School) Survey for Students.

IntroductionFew instruments assess key outcomes of school-based obesity interventions, including student perceptions of school environments and school-specific dietary intake patterns. This study describes development of PEA-PODS (Perceptions of the Environment and Patterns of Diet at School), a 2-part survey to measure these outcomes.MethodsPart 1 (PEA) assessed student perceptions of policies, physical environment, and practices related to healthy eating and physical activity at school. Part 2 (PODS) assessed usual intake (ie, frequency, location obtained, and foods consumed) of breakfast and lunch. Foods consumed were presented by MyPlate categories (eg, Fruits, Grains). Students in grades 3, 6, and 9 participated in 2 phases: cognitive pre-testing (n = 10) and reliability/validation testing (n = 58). Both surveys were administered 1 week apart to assess test-retest reliability and 5-day food records validated PODS. Analyses included percent agreement (70% = acceptable), Pearson correlations, and Cronbach α.ResultsCognitive pre-testing provided feedback on content, length, and age-appropriateness. Percent agreements were acceptable for test-retest reliability of PEA (71%–96%). The final version included 34 items with Likert-type responses in 4 subscales (α ≥0.78). For PODS, agreement for breakfast and lunch location was ≥75% for both reliability and validation. For foods consumed at breakfast, reliability agreement ranged from 74% to 93%, and validation agreement from 68% to 91%. For foods consumed at lunch, agreement ranges were 76% to 95% and 73% to 88%, respectively.ConclusionBoth parts of the instrument demonstrate acceptable reliability, and PODS demonstrates acceptable validity. This demonstrates appropriateness for assessing perceptions of the environment and usual dietary intake patterns for school-based obesity prevention initiatives.

The Influence of Organizational Culture on School-Based Obesity Prevention Interventions: A Systematic Review of the Literature.

Although the influence of organizational culture has been examined on a variety of student outcomes, few studies consider the influence that culture may have on school-based obesity prevention interventions. We present a systematic review of the literature to examine how elements of organizational culture may affect the adoption, implementation, and sustainability of school-based obesity prevention interventions. Fourteen studies examining the impact of organizational-level characteristics on school-based obesity prevention interventions were identified through the online databases EBSCO (CINAHL, ERIC, Agricola), Web of Science, Medline (PubMed), and Scopus. Five themes were identified as elements of organizational culture that influence the adoption, implementation, and sustainability of school-based obesity prevention interventions: organizational response to limited resources, value placed on staff training and professional development, internal support, organizational values, and school climate. Organizational culture can greatly influence the success of school-based obesity interventions. The collection of data related to organizational-level factors may be used to identify strategies for creating and sustaining a supportive environment for obesity prevention interventions in the school setting.

Juara Sihat™: Study Design of a School-based Childhood Obesity Nutrition Education Programme in Kuala Lumpur, Malaysia

Globally, prevalence of overweight and obesity among children has increased rapidly in the recent decades. Thus, development of effective interventions to prevent childhood obesity in Malaysia is urgently needed. This paper describes the study design of a 12-week multi-component, school-based nutrition education programme aimed at managing childhood obesity. The objective of Juara Sihat™ is to determine the effectiveness of a nutrition education programme in improving anthropometric status, knowledge, attitude and practice (KAP) of nutrition, eating habits and physical activity level among overweight and obese children. This quasi-experimental study involves two primary schools in Kuala Lumpur with similar demographic characteristics. Eligibility criteria of research participants are overweight and obese children aged 9 to 11 years. The main components of the Juara Sihat™ intervention are nutrition education classes on healthy eating and active lifestyle; physical activity sessions; and active involvements of parents and teachers. The control school does not receive any interventions. The primary outcome is BMI z-score, while other outcomes include waist circumference, body fat percentage, KAP of nutrition score, dietary intake, physical activity level, sedentary behaviour and biochemical profile. Outcome measures will be assessed at three intervals: baseline, post-intervention 1 (3-month follow-up), and post-intervention 2 (6-month follow-up). The Juara Sihat™ programme represents a promising approach to examining the effectiveness of a school-based childhood obesity intervention with strong empowerment of Parents’ and Teachers’ Association (PTA). We anticipate that this study may provide insights towards the development of more effective strategies in formulating childhood obesity interventions. DOI : http://dx.doi.org./10.17576/JSKM-2018-17

Juara Sihat™: Study Design of a School-based Childhood Obesity Nutrition Education Programme in Kuala Lumpur, Malaysia

Globally, prevalence of overweight and obesity among children has increased rapidly in the recent decades. Thus, development of effective interventions to prevent childhood obesity in Malaysia is urgently needed. This paper describes the study design of a 12-week multi-component, school-based nutrition education programme aimed at managing childhood obesity. The objective of Juara Sihat™ is to determine the effectiveness of a nutrition education programme in improving anthropometric status, knowledge, attitude and practice (KAP) of nutrition, eating habits and physical activity level among overweight and obese children. This quasi-experimental study involves two primary schools in Kuala Lumpur with similar demographic characteristics. Eligibility criteria of research participants are overweight and obese children aged 9 to 11 years. The main components of the Juara Sihat™ intervention are nutrition education classes on healthy eating and active lifestyle; physical activity sessions; and active involvements of parents and teachers. The control school does not receive any interventions. The primary outcome is BMI z-score, while other outcomes include waist circumference, body fat percentage, KAP of nutrition score, dietary intake, physical activity level, sedentary behaviour and biochemical profile. Outcome measures will be assessed at three intervals: baseline, post-intervention 1 (3-month follow-up), and post-intervention 2 (6-month follow-up). The Juara Sihat™ programme represents a promising approach to examining the effectiveness of a school-based childhood obesity intervention with strong empowerment of Parents’ and Teachers’ Association (PTA). We anticipate that this study may provide insights towards the development of more effective strategies in formulating childhood obesity interventions. DOI : http://dx.doi.org./10.17576/JSKM-2018-17

Follow-up of a healthy lifestyle education program (the EdAl study): four years after cessation of randomized controlled trial intervention

BackgroundAn important challenge of school-based childhood obesity (OB) intervention programs is understanding the maintenance of the effects after cessation of the intervention to overcome the limitations of follow-up studies. The aim of this study is to verify the sustainability of the benefits achieved at a 4-year follow-up of the post-Educació en Alimentació (EDAl) program intervention cessation by assessing the OB-related outcomes and lifestyles of 13- to 15-year-old adolescents.MethodsThis paper describes a 4-year follow-up study after the cessation of a school-based randomized controlled intervention in adolescents (n = 349, intervention; n = 154, control) with baseline and 4-year follow-up data from high schools in Reus (intervention group), Salou, Cambrils and Vila-seca (control group). The outcomes are body mass index (BMI), BMI z-score, and OB prevalence according to the World Health Organization and International Obesity Task Force criteria and lifestyle data (obtained from questionnaires).ResultsCompared with the control girls, the intervention girls showed reduced BMI z-scores (−0.33 units, p < 0.01) from baseline (2007) to the 4-year follow-up post-intervention (2014). Compared with the control boys, the intervention boys showed reduced OB prevalence (−7.7%; p = 0.02). Compared with the control boys, more boys in the intervention group (19% increase; p = 0.059) showed ≥4 h/week after-school physical activity (PA). A decrease in the consumption of dairy products, fruits and fish was observed in both groups.ConclusionsAt the 4-year post-intervention follow-up of the EdAl program, compared with the control groups, girls had lower BMI z-scores and boys had lower OB prevalence from the intervention. The encouragement in after-school PA was long-lasting and maintained after the cessation of the intervention, whereas healthy food habits must be further reinforced in adolescents.Trial registrationISRCTN29247645.

Compañeros: High School Students Mentor Middle School Students to Address Obesity Among Hispanic Adolescents.

Introduction Promotoras, Hispanic community health workers, are frequently employed to promote health behavioral change with culturally bound Hispanic lifestyle behaviors. Peer health mentors have been used in schools to promote healthy nutrition and physical activity behaviors among students. This study investigates the efficacy of combining these 2 approaches by training high school health mentors, called compañeros, to engage Hispanic middle school students in a school-based obesity intervention as a strategy to promote and sustain reductions in standardized body mass index (zBMI).MethodsHigh school compañeros were trained to participate in a 6-month obesity program alongside middle school students in Houston, Texas. Middle school students were randomized to participate in the program either with compañeros (n = 94) or without compañeros (n = 95). The intervention was conducted from 2013 through 2016 in 3 cohorts of students, 1 each school year. Students were followed for 12 months. The primary outcome was zBMI, which was analyzed at baseline, 6 months, and 12 months.ResultsSignificant differences were found between conditions across time (F = 4.58, P = .01). After the 6-month intervention, students in the condition with compañeros had a larger decrease in zBMI (F = 6.94, P = .01) than students in the condition without compañeros. Furthermore, students who received the intervention with compañeros showed greater sustained results at 12 months (F = 7.65, P = .01).ConclusionUsing high school compañeros in an obesity intervention for Hispanic middle school students could be effective in promoting and maintaining reductions in zBMI.