School-based Obesity Prevention Program Research Articles

Effectiveness of a school-based obesity prevention program on the BMI Z-score and body fat at 6 months in Mexican children: study protocol of a cluster randomized controlled trial

School-based obesity prevention programs show positive effects on obesity and lifestyle parameters. However, the most efficient way of implementing them is unknown. In Mexico, available studies present methodological limitations. The aim of this study is to evaluate the feasibility and effectiveness of a school-based obesity prevention program 1) implemented by advanced undergraduate nutrition and physical activity students, and 2) the same program implemented by schoolteachers and advanced undergraduate physical activity students, each compared to a control group of Mexican children. This study is a cluster randomized controlled trial. Children from several schools in Hermosillo, Sonora, Mexico will be invited to participate. The schools will be randomly assigned to one option: 1) the Planet Nutrition Program (PNP) delivered by advanced undergraduate nutrition and physical activity students, 2) PNP by schoolteachers, or 3) a control group. The intervention will consist of nutritional education and physical activity sessions for children and nutrition information for parents. The BMI Z-score, body fat, and lifestyle parameters will be evaluated at baseline and at 6 months. If successful, we expect that the program turns out a model for obesity prevention in this age group, with a potential for dissemination in Mexican schools.

School-based obesity prevention programs in rural communities: a scoping review.

The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature. Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities. We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data. A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives. Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations. Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.

Healthy Schoolhouse 2.0 Strides toward Equity in Obesity Prevention.

Background: Over the past two decades, childhood obesity has been recognized as an increasing health problem with stark disparities by race, ethnicity, and zip code. A single-level intervention that focuses on individual choices has limited success especially in under-resourced communities. Methods: The "Getting to Equity" model provides a framework for building interventions that incorporate multilevel strategies. We applied this model to an elementary school-based obesity prevention program. Results: By applying the "Getting to Equity" framework, we demonstrate how a school-based program aligns with the quadrants within the framework to holistically address childhood obesity. Conclusion: By applying this model to an elementary school-based obesity prevention program, we demonstrate how program leaders can address childhood obesity while advancing health equity.

Effectiveness of school-based obesity prevention programme among elementary school children in Jakarta

Introduction: Prevention and treatment of overweight and obesity are easier in children than in adults. This study was conducted to evaluate the Smart Eating and Healthy Activity (SEHAT) programme, an intervention programme involving parents, teachers, and students in Indonesia to prevent obesity at schools. The intervention was conducted in the form of seminars and leaflets distribution to parents, training of teachers, training of student health cadres, training of students by trained teachers, health promotion to school canteen vendors, and promoting healthy home food weekly. Methods: This non-randomised controlled trial study was conducted from January to May 2016 in North Jakarta. The primary outcome was body mass index (BMI) changes measured with SECA® digital scale for weight and microtoise for height measurements. The secondary outcomes were changes in children’s knowledge, self-efficacy and behaviours, measured using self-made questionnaires, and physical activity using the Physical Activity Questionnaire for Older Children (PAQ-C). A total of 278 fourth and fifth-grade elementary school students aged 9 to 11 years old were recruited and grouped into intervention group (121 students) and control group (157 students). Results: The study reported a significant change between intervention and control groups on knowledge (1.28 vs 0.31), attitude (1.85 vs 0.06), physical activity (0.14 vs -0.32), eating fruits and vegetables (0.02 vs -0.78), and BMI (0.33 vs 0.71). Conclusion: The five-month SEHAT intervention programme effectively promoted knowledge on healthy eating and physical activity for obesity prevention by increasing physical activity, eating fruits and vegetables, and maintaining students’ BMI.

Preliminary Results of the Planet Nutrition Program on Obesity Parameters in Mexican Schoolchildren: Pilot Single-School Randomized Controlled Trial.

School-based obesity prevention programs are key to promoting healthy habits. The aim of this study was to evaluate the effect of the Planet Nutrition program on BMI z-score and other parameters compared to a control group of Mexican schoolchildren after 9 weeks of intervention. The effect of the summer holidays on the BMI z-score was also evaluated at 23 weeks. A pilot randomized controlled trial design was used and 41 schoolchildren were randomized (21 intervention group and 20 control). The program included 18 nutrition education sessions, 20 physical activity classes and six brochures for parents. At 9 weeks, no significant differences were found between the intervention and control groups in the change in BMI z-score (−0.11, 95% CI −0.23, 0.01). Significant differences were observed in some secondary outcomes: body fat percentage (−1.72, 95% CI −3.42, −0.02), waist circumference (−3.45, 95% CI −5.55, −1.36), physical activity (0.44, 95% CI 0.01, 0.88) and nutrition knowledge (1.15, 95% CI 0.27, 2.03). Summer holidays negatively affected the BMI z-score in both groups, reducing the difference observed between groups at 9 weeks (−0.07, 95% CI −0.22, 0.07). The Planet Nutrition program showed favorable effects in some obesity and lifestyle parameters in the short term.

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.

Impact of a Three-Year Obesity Prevention Study on Healthy Behaviors and BMI among Lebanese Schoolchildren: Findings from Ajyal Salima Program.

Most school-based obesity prevention programs in low- to middle-income countries are of short duration, and few undertake follow-up analyses after the termination of the project. The aims of the current study are to investigate (1) the long-term effects of a school-based intervention program when implemented over two years on body mass index (BMI), healthy dietary behaviors, and physical activity (PA); and (2) whether the effects are sustained after one-year washout. The study is a cluster-randomized trial; 36 public and private schools were randomized into either intervention or control groups. Students (8–12 years) completed pre-and post-assessment anthropometric measurements and questionnaires about their eating and physical activity habits. Students in the intervention groups received the program components for two consecutive years. Multiple logistic regression models were used to examine the effect of the intervention on BMI and healthy behaviors. Students in the intervention groups were less likely to be overweight at washout, only in public schools. The number of children reporting change in dietary behaviors significantly increased in intervention groups, with a sustained effect only in public schools. Policies aiming at securing a positive nutrition environment in schools, and adoption of nutrition programs, are needed for achieving sustained behavior and prompting BMI changes in children.

Differential effects of a school-based obesity prevention program: A cluster randomized trial.

School‐based healthy living interventions are widely promoted as strategies for preventing obesity. The peer‐led Healthy Buddies™ curriculum has been shown to improve obesity‐related outcomes in school‐aged children. We examined whether these improvements existed among subgroups of children stratified by sex, income level and urban/rural geography. In a cluster‐randomized controlled trial, elementary schools in Manitoba, Canada, were randomly allocated to Healthy Buddies™ (10 schools, 340 students) or standard curriculum (10 schools, 347 students). Healthy Buddies™ participants had 21weekly lessons on healthy eating, physical activity and self‐efficacy, delivered by children age 9–12 to children age 6–8. We assessed pre‐ and post‐intervention body mass index (BMI) z‐scores, waist circumference, healthy living knowledge, dietary intake and self‐efficacy among the younger children. Compared to standard curriculum (n = 154), Healthy Buddies™ participants (n = 157) experienced a greater reduction in waist circumference (−1.7 cm; 95% confidence interval [CI][−2.8, −0.5 cm]) and improved dietary intake (4.6; 95% CI [0.9, 8.3]), healthy living knowledge (5.9; 95% CI [2.3, 9.5]) and self‐efficacy (5.3; 95% CI [1.0, 9.5]) scores. In subgroup analyses, effects for waist circumference (−2.0 cm; 95% CI [−3.6, −0.5]), healthy living knowledge (9.1; 95% CI [4.4, 13.8]) and self‐efficacy (8.3; 95% CI [3.3, 13.3]) were significant among boys. Dietary intake (10.5; 95% CI [5.5, 15.4]), healthy living knowledge (9.8; 95% CI [4.5, 15.0]) and self‐efficacy (6.7; 95% CI [0.7, 12.7]) improved among urban‐dwelling but not rural‐dwelling children. Healthy Buddies™ was effective for boys and children living in urban settings. Enhanced curricula may be needed to improve program effectiveness for select subgroups of school‐aged children.

Practicability of Implementing a Pilot School Based Obesity Prevention Program

Unhealthy diet and lifestyle behaviours are known to increase the risk of obesity and comorbidities. This article piloted the practicability of a school-based prevention program to control weight among schoolgirls. An eight-week comprehensive program was conducted on 66 adolescent females. Food habits and lifestyle survey was completed. Student health, nutrition, and physical activity knowledge was assessed. Physical education was applied. Subjective assessment of food/beverages at the school's canteen occurred and a sample of a healthy canteen was provided. Results showed students' unhealthy patterns in food habits and lifestyle. Significant changes were noticed in their overall positive responses to pre-and post-questions (P-value=001). Nearly 70% of food/beverage items were categorised as less healthy. School-based obesity prevention programs could support students in improving their eating patterns and weight status. The program could be replicated to improve students' lives in other locations. Benefits could include health and education ministries.

57-OR: A Novel School-Based Obesity Prevention Program Improves Healthy Eating/Lifestyle among 5- to 7-Year-Olds

Background: The foundation for lifelong good health is laid in childhood. Schools can play a pivotal role in preventing obesity/type 2 diabetes with effective interventions. Methods: We devised a novel school-based program using a sticker based food diary (FD) and colorful 12-page story book to motivate young school children to adopt a healthier diet/lifestyle. This study to conducted among 1500 grade 1 and 2 students from 4 schools between March 2018- April 2019, to evaluate its effectiveness. During the first week(W1), each child self-monitored his/her food intake daily at home for a week, using the FD, and received a Smiley Face based Score (SFS) based on the healthiness of each meal. In the second week, class teachers read the story book (illustrating the physical and psychosocial effects of obesity and benefits of healthy lifestyle in a child friendly manner). In the third week(W3) children completed the FD again. Effectiveness of the program to improve healthy eating/lifestyle was assessed by comparing mean SFS between W1 and W3, and by anonymized graded-response and open response questionnaires completed by parents and class teachers. Results: Completed FDs were returned by 1029 students. Overall there was an improvement in healthy eating, with mean SFS increasing by 11.7% from W1 to W3 (51.3 ± 22.9 vs. 63.1 ± 24.2, p< 0.001). SFS improved >10% in all BMI categories. SFS improvement was more in boys (13.0 vs. 9.7, p=0.02), and in 2nd graders compared to 1st graders (13.1 vs. 10.3, p=0.045). Majority of responding parents (> 90%) and teachers (95%) strongly agreed/agreed that this program motivated children towards a healthier lifestyle and led to an observable improvement in food habits. Conclusion: This novel program led to a demonstrable improvement in healthy lifestyle among 5-7 year olds and was received favorably by parents and teachers. Based on these results and positive (ongoing) longer-term follow up data, wider implementation involving 750,000 children is planned for mid 2020. Disclosure S.N. Seneviratne: None. S. Sachchithananthan: None. P.S. Angulugaha Gamage: None. S. Ramamoorthy: None. R. Peiris: None. V.P. Wickramasinghe: None. N. Somasundaram: None. Funding World Diabetes Foundation (WDF15-1291)

Assessing the Effectiveness of an Extender Model Partnership in Implementing a Multicomponent, School-Based Nutrition Intervention

Childhood obesity continues to be a problem of national concern; school-based obesity prevention programs that incorporate nutrition education are among the efforts to address this issue. Implementation of these programs is often conducted through partner agencies like the Supplemental Nutrition Assistance Program Education (SNAP-Ed). As educators within these agencies have limited time and many schools qualify for programming, developing programs that extend reach by partnering with classroom teachers to deliver nutrition education is critical. The purpose of this article is to evaluate the effectiveness of a teacher extender model compared with direct nutrition education from trained staff using the research-tested, evidence-based Shaping Healthy Choices Program. Data collected as part of this evaluation in intervention and control groups included nutrition knowledge, body mass index percentile, and vegetable identification in youth; lesson fidelity observations and feasibility from teachers; and demographics from parents. Overall, unequal within variances did not allow for the statistical power to detect change. Generally, teachers enjoyed the program but found it too time-consuming to implement. While results were unclear, important lessons were learned regarding the implementation of extender programs warranting further research. Overall, this study aligns with others in the literature that indicate time is a major barrier to implementing nutrition education in the classroom. This study underscores the need for policy mandating nutrition education in schools.

Cross-sectional changes in weight status and weight related behaviors among Australian children and Australian Indigenous children between 2010 and 2015.

BackgroundSince 2006 there has been substantial long-term investment in school-based child obesity prevention programs in New South Wales (Australia). Whether these programs have led to population level improvements in children’s weight status and weight-related behaviors are yet to be determined. The purpose of this study was to describe changes in children’s weight status and weight-related behaviors, including Indigenous children, who are at greater risk of poorer health outcomes than non-Indigenous children.MethodsRepresentative cross-sectional population surveys conducted in 2010 and 2015 among children age 5–16 years (n = 15,613). Objective measurements included height, weight, waist circumference, cardiorespiratory fitness, and fundamental movement skills. Indigenous status and indicators of weight-related behavior (i.e., diet, physical activity, school travel, screen-time) were measured by questionnaire with parents responding for children age <10 years and self-report by children age ≥10 years.ResultsThe prevalences of overweight/obesity, obesity and abdominal obesity were higher in 2015, than 2010, and higher among Indigenous than non-Indigenous children at both timepoints. There were some small positive changes towards healthier weight-related behaviors between surveys among all children, but many unhealthy weight-related behaviors remain highly prevalent. The magnitude of changes and the 2015 prevalences of weight-related behaviors were generally similar for Indigenous and non-Indigenous children.ConclusionsSchools play an important role in health promotion, but our findings suggest the current approaches need re-thinking. Upstream factors that shape weight-related behaviors such as the regulation of the food industry and food environment, urban, neighborhood and public transport planning must be including in solutions to ensure populations can eat healthily and be physical active.

Pemanfaatan sekolah sebagai sarana pencegahan obesitas sejak dini pada remaja

Obesity among adolescents is a new nutritional problem in Indonesia. This is not only associated with increased risk for obesity in later life but also increased the risk for cardiovascular diseases, type 2 diabetes mellitus, hypertension, and other non-communicable diseases. Therefore an effective and integrated obesity prevention program is highly warranted. There are several community-based programs for obesity prevention that have been developed in the past few decades and school-based activity is one of the potential programs that could be implemented in the Indonesian setting. School is a strategic location for obesity prevention programs in the adolescents because school is the place where most of the adolescents spending their time outside their home. In addition, a school also a centralized community where health and nutrition promotion programs can be done at the same time. In 2012, the Indonesian Ministry of Health published a guidebook on the prevention and treatment of adolescents with obesity at school. However, this guideline only focusing on the role of health workers at puskesmas level and not detailing the role of the school in managing obesity prevention program. Thus, this review was made to provide an alternative solution for obesity prevention in adolescent via programs that can be done at school. Author aimed this review for school managers, puskesmas health workers, the local department of health, researcher and non-government organization that has the concern regarding adolescents health especially in relation to nutrition. This review can be a foundation for the development and implementation of school-based obesity prevention programs as well as a reference for the development of school policy.

School-based obesity prevention programs in rural communities: a scoping review protocol.

The objective of this scoping review is to map the available literature on school-based obesity prevention programs in rural communities. Significant health disparities are associated with childhood obesity, and these disparities disproportionately affect children in disadvantaged communities, such as rural areas. Youth in rural areas are 26% more likely to be obese than youth in urban communities. To combat obesity in children, schools have become an avenue for educating children about the importance of healthy diet and physical activity. Although many school-based obesity prevention programs have been implemented in recent years, more information is needed on programs in rural communities. This scoping review will consider studies that include children 5 to 18 years of age who are enrolled in elementary, middle or high school in a rural setting and that investigate school-based obesity prevention programs. Studies that include children who are in non-rural areas, who are home-schooled, who are in an alternative setting (e.g. juvenile detention) or who are hospitalized will be excluded. Studies published in English since 1990 will be included. Multiple databases will be searched, including PubMed, CINAHL, ERIC, Embase, Scopus and Academic Search Premier. Trials registers and gray literature will also be searched. After screening the titles and abstracts of identified citations, potentially relevant studies will be retrieved in full. Data will be extracted by independent reviewers and presented in a diagrammatic or tabular form, accompanied by a narrative summary.

The Need for a School-based Student Obesity Prevention Program: Perceptions of Rural Elementary Principals

This phenomenological study investigated the perceptions of elementary principals regarding the need for a school-based student obesity prevention at eight, rural elementary schools in North Central Texas. Face to face interviews were the primary method of data collection from the eight participants. Findings indicated that school-based obesity prevention programs are needed to decrease the occurrence of student obesity, improve student diets and health related behaviors, educate families on obesity prevention measures, and improve the academic performance of students. The need to inform and include relevant stakeholders in the creation and implementation of school-based obesity prevention programs was identified as an essential component to the success of the program. The findings provide school leaders with components needed for an effective school-based obesity prevention program along with barriers for consideration.

Effect of a community-based childhood obesity intervention program on changes in anthropometric variables, incidence of obesity, and lifestyle choices in Spanish children aged 8 to 10years.

The TCHP did not improve weight development, diet quality, and physical activity in the short term. What is Known: • There is inconsistent evidence for the efficacy of school-based childhood obesity prevention programs. • There is little evidence on the efficacy of childhood obesity intervention programs in other settings. What is New: • This paper contributes information about the efficacy of a multisetting and multistrategy Community Based Intervention (CBI) program that uses the municipality as its unit of randomization. • This CBI had no effect on the prevention and treatment of childhood obesity in the short term.

Obesity Prevention Interventions in US Public Schools: Are Schools Using Programs That Promote Weight Stigma?

IntroductionDespite substantial research on school-based obesity prevention programs, it is unclear how widely they are disseminated. It is also unknown whether schools use obesity programs that inadvertently promote weight stigma or disordered weight-control behaviors.MethodsIn spring 2016, we distributed an online survey about school wellness programming to a simple random sample of US public school administrators (N = 247 respondents; 10.3% response rate). We analyzed survey responses and conducted immersion/crystallization analysis of written open-ended responses.ResultsSlightly less than half (n = 117, 47.4%) of schools offered any obesity prevention program. Only 17 (6.9%) reported using a predeveloped program, and 7 (2.8%) reported using a program with evidence for effectiveness. Thirty-seven schools (15.0%) reported developing intervention programs that focused primarily on individual students’ or staff members’ weight rather than nutrition or physical activity; 28 schools (11.3% of overall) used staff weight-loss competitions. School administrators who reported implementing a program were more likely to describe having a program champion and adequate buy-in from staff, families, and students. Lack of funding, training, and time were widely reported as barriers to implementation. Few administrators used educational (n = 12, 10.3%) or scientific (n = 6, 5.1%) literature for wellness program decision making.ConclusionEvidence-based obesity prevention programs appear to be rarely implemented in US schools. Schools may be implementing programs lacking evidence and programs that may unintentionally exacerbate student weight stigma by focusing on student weight rather than healthy habits. Public health practitioners and researchers should focus on improving support for schools to implement evidence-based programs.

Maternal concerns and perceptions of elementary school-age children's weight status.

The purpose of this study was to identify characteristics associated with maternal concerns for her child becoming overweight, and how these concerns are related to her perceptions of her child's weight. A school-based sample of 55 children and their mothers from Houston, Texas, participated in a cross-sectional survey. Mothers reported on their concerns and perceptions regarding their child's weight. Child and mother height and weight were directly assessed to calculate body mass index (BMI). Covariate-adjusted logistic regression models were conducted. Over one-third of mothers misperceived their child's weight status [9% (n=5) overestimated; 27% (n=15) underestimated]. Mothers of sons were less accurate compared with mothers of daughters. For every one unit increase in maternal BMI, mothers had 13% higher odds of being concerned of their child becoming overweight. Concerned mothers had 82% lower odds of underestimating their child's weight. In order for school-based childhood obesity prevention and intervention programs to be successful, parents must accurately perceive their elementary school-age child's weight status. School nurses can be vital to these efforts through proper training and resources. Nurses can use the "School Nurse Childhood Obesity Toolkit" and motivational interviewing techniques to address parental concerns and perceptions prior to teaching behavior modification strategies to children/families.

A clustered randomized controlled trial to determine impacts of the Harvest of the Month program.

The study purpose was to examine the impact of the Harvest of the Month (HOTM) program on fruit and vegetable (FV) consumption, FV preferences, other eating behaviors, physical activity and other variables related to healthy eating. A clustered randomized controlled trial was employed in 28 elementary schools. After parental consent was obtained, students in grades 4-6 were randomly assigned to treatment and control conditions (Intervention= 127, Control= 148). Students in the intervention group participated in HOTM, a widely used school-based nutrition promotion and obesity prevention program. Control group schools continued their usual practice. Participants completed baseline and follow-up surveys measuring fruit and vegetable (FV) consumption, FV preferences, other eating behaviors, physical activity, FV knowledge and self-efficacy to eat, prepare and ask for FV. No impacts of HOTM were found for FV consumption or other nutritional behaviors, physical activity, FV knowledge, or self-efficacy. A positive impact of the program was only found for FV preferences. This study suggests that the HOTM program did not affect eating behaviors or physical activity behaviors. The evidence base regarding school-based nutrition education programs including HOTM could be strengthened by the use of more rigorous impact evaluations to examine their effectiveness prior to wide-spread use.

Abstract IA09: Realizing the promise of prevention (at the personal and population levels)

Abstract IA09: Realizing the promise of prevention (at the personal and population levels)