Research ArticleImplementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial
Section snippets
INTRODUCTION
Schools have figured prominently in national discourse about policy approaches to prevent childhood obesity because they afford concentrated contact, teach health education, provide meals, and can model health-promoting environments.1, 2, 3 In 2004, all school districts participating in the U.S.’s federal meal programs were required to create a committee of stakeholders and write a school wellness policy.4 School wellness policies required schools to set goals for physical education and
METHODS
This study was conducted in New Haven, Connecticut, an urban district with >21,000 students. Using a quantitative coding system to evaluate written school wellness policies in all Connecticut districts, New Haven's policy scored higher than any other district.18, 19 Therefore, it was an ideal setting to assess implementation of a strongly written school wellness policy.
Twelve schools (kindergarten through eighth grade [K–8]) were randomly selected from among the 50 K–8 district schools. All
RESULTS
Mean age of students at study entry was 10.9 years (SD=0.6). Racial/ethnic categorization generally reflected distribution of students in the district: 47.2% Hispanic, 35.0% black, and 17.8% white/other. Students in study conditions did not differ by age or race. Girls accounted for 54% of participants. The physical activity–only condition had significantly more girls; the largest study school, randomized to this condition, was a school where two thirds of students were female. Mean age- and
DISCUSSION
Students who attended schools that were randomized to receive support to implement nutrition-focused school wellness policies were significantly less likely to experience an increase in BMI across middle school (from fifth through eighth grades) than students in comparison schools. At the end of the study, these students reported lower consumption of unhealthy foods and sugar-sweetened beverages, although there was no effect on consumption of healthy foods and beverages. The magnitude of
CONCLUSIONS
Implementation of school-based nutrition policies should be an important component of multisector interventions to prevent an adverse trajectory of weight gain. This trial—focused on school wellness policy support and implementation—had a larger effect than previous studies, indicating that school-based structural interventions may be particularly promising. School systems should consider earlier interventions; in this study, more than one half of students were already overweight or obese by
ACKNOWLEDGMENTS
This study was funded by the National Institute of Child Health and Human Development, NIH (1R01 HD070740, JR Ickovics and MB Schwartz, Multiple PIs), with additional support from the U.S. Centers for Disease Control and Prevention and Yale-Griffin Prevention Research Center (5U48DP000053, JR Ickovics, PI). The funders had no role in the design, implementation, evaluation, or interpretation of this study. More information on the protocol is available at ClinicalTrials.gov NCT02043626.
No
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