The impact of school-based prevention of overweight on psychosocial well-being of children

The Role of Ethnicity in School-Based Obesity Intervention for School-Aged Children: A Pilot Evaluation

BACKGROUND

Rates of obesity have risen disproportionately for ethnic minority youth in the United States. School-based programs may be the most comprehensive and cost-effective way to implement primary prevention in children. In this study we evaluated the effect of a school-based obesity prevention on the outcome of body mass index percentile (BMI%), with baseline weight class and ethnicity examined as moderators.

METHODS

Participants (N = 125), ages 7-11 (56% female) from 4 urban, low-income, ethnic minority (58% black, 42% Latino) schools were recruited. Two schools received the Urban Initiatives Work to Play health intervention, and 2 demographically matched schools served as wait-list controls.

RESULTS

Hierarchical multiple regression was used to analyze the independent and interactive effects of key variables on BMI%. An interaction between intervention status and ethnicity revealed Latino youth in the intervention had lower BMI% than those in the control group. Participation did not cause BMI% outcomes to decrease for black participants.

CONCLUSIONS

The study demonstrates the intervention is effective, but that the effectiveness varies across ethnicity. Interventions can be made more efficient and cost-effective by targeting youth of a common ethnicity that has shown empirical responsiveness to certain program elements.

Mediators of Psychological Well-being in Adolescent Boys

PURPOSE

The aim of this study was to explore the effect of the Active Teen Leaders Avoiding Screen-time (ATLAS) intervention on psychological well-being in adolescent boys and to examine the potential mediating mechanisms that might explain this effect.

METHODS

ATLAS was evaluated using a cluster randomized controlled trial in 14 secondary schools located in low-income communities (N = 361 adolescent boys, mean age = 12.7 ± .5 years). The 20-week intervention was guided by self-determination theory and involved: professional development for teachers, provision of fitness equipment to schools, enhanced school sport sessions, researcher-led seminars, a smartphone application, and parental strategies for reducing screen time. Assessments were conducted at baseline and immediately post intervention (8 months). Psychological well-being was measured using the Flourishing Scale. Motivational regulations (intrinsic, identified, introjected, controlled, and amotivation) and basic psychological needs (autonomy, competence, and relatedness) in school sport, muscular fitness, resistance training skill competency, and recreational screen time were examined as potential mediating mechanisms of the intervention effect.

RESULTS

The intervention effect on well-being was small but statistically significant. Within a multiple mediator model, changes in autonomy needs satisfaction, recreational screen time, and muscular fitness significantly mediated the effect of the intervention on psychological well-being.

CONCLUSIONS

In addition to the physical health benefits, targeted physical activity programs for adolescent boys may have utility for mental health promotion through the mechanisms of increasing autonomy support and muscular fitness and reducing screen time.

Bidirectionality and gender differences in emotional disturbance associations with obesity among Taiwanese schoolchildren

Childhood obesity is associated with psychological problems, but little is known about its association with emotional disturbance (ED) in the educational setting, especially by gender. In the population representative Elementary School Children's Nutrition and Health Survey in Taiwan 2001-2002 of children aged 6-13 (n=2283), we have considered whether ED is associated with obesity by gender. Schoolchildren were assessed with the modified scale for assessing emotional disturbance questionnaires. For some subscales, boys and girls had ED associations with obesity which were bidirectional. With normal weight as referent and relevant adjustments, the significant ED subscales predictable by obesity were relationship problems (RP) in boys (odds ratio, OR=1.89 with 95% CI: 1.08-3.30) and inappropriate behavior (IB) in girls (OR=2.88: 95% CI: 1.47-5.61). Conversely, with 'no-specific-ED' as referent, obesity was predictable by fully-adjusted specific-EDs in the same subscales, namely RP in boys (OR=1.88 with 95% CI: 1.13-3.13) and IB in girls (OR=3.03: 95% CI: 1.57-5.85). Child obesity prevalence showed no trend with school grade from 1 to 6, but for aggregate ED and most of its subscales the prevalence increased with grade (P for trend <0.01). Thus, there is some dissociation of obesity and ED as judged by their trend presence with school grade. Where obesity and ED occurred together (for inability-to-learn and unhappiness or depression), there were upward trends with grade (P<0.01). There are probably some selected bidirectional pathogenicities for obesity-ED associations with different expression in boys and girls and during elementary education. This provides some policy direction while mechanisms and causality require elucidation.

Physical activity promotion and obesity prevention in Girl Scouts: Scouting Nutrition and Activity Program+

BACKGROUND

A previous version of Scouting Nutrition and Activity Program (SNAP) resulted in greater physical activity (PA) during troop meetings, but no impact on girls' body mass index (BMI) or overall PA. The purpose of this study was to evaluate the effects of a 6-month intervention that coupled the evidence-based program SNAP with a channel of communication to parents using health report cards.

METHODS

Thirty-two Girl Scouts (mean age = 9.5, SD = 1.4 years) received the SNAP+ intervention. Girls were measured before and after the intervention on body composition, BMI, and 7-day step counts. Troop leaders were trained to implement an interactive obesity-prevention curriculum. Parents received health report cards designed to provide personalized information about their daughters' PA and weight status.

RESULTS

The full sample of participants took more steps per day after the intervention (mean difference = 1741, P= 0.007). Results showed that lower values for body fat percentage (P= 0.620), BMI percentile (P= 0.100) and BMI z-scores (P= 0.055) at intervention end were not statistically significant. In the subsample of girls at risk for overweight and obesity, there were lower values for BMI z-score (P= 0.010), BMI percentile (P= 0.027), and body fat percentage (P= 0.053).

CONCLUSIONS

From this preliminary study, the SNAP+ intervention appears to be effective for Scout-based promotion of PA, and for the prevention of overweight and obesity in at-risk Girl Scouts, but further evaluation through a fully powered randomized controlled trial is warranted.

Improving physical self-perception in adolescent boys from disadvantaged schools: psychological outcomes from the Physical Activity Leaders randomized controlled trial

OBJECTIVES

To evaluate the effect of a school-based obesity prevention programme on physical self-perception and key physical-activity related cognitions in adolescent boys from disadvantaged secondary schools. A secondary objective was to determine if any psychological changes were associated with improved weight status.

METHODS

Participants (n = 100, age = 14.3[0.6]) were randomized to the PALS (Physical Activity Leaders) intervention (n = 50) or a control group (n = 50) and assessed at baseline, 3- and 6-month follow up. Measures included BMI, BMI z-score and % body fat (bioelectrical impedance analysis). Students also completed the Children's Physical Self-Perception Profile and a physical activity-related cognitions questionnaire. The findings include secondary data analyses.

RESULTS

Relative to the controls, the PALS group significantly increased their physical self worth (p = .01), perceived physical condition (p = .02), resistance training self efficacy (p < .001) and their use of physical activity behavioural strategies (p = .02).

CONCLUSIONS

A school-based obesity prevention programme that targeted leadership skills improved psychological health in the physical domain in adolescent boys from disadvantaged schools.

Perceived social support and its association with obesity-specific health-related quality of life

OBJECTIVE

To (1) describe type and source of social support perceived by obese youth and examine associations with sociodemographic/anthropometric characteristics, and (2) examine relationships between social support and obesity-specific health-related quality of life (HRQOL).

METHODS

Seventy-four obese youth and their primary caregivers participated. Youth completed the Child and Adolescent Social Support Scale and an obesity-specific HRQOL measure, Sizing Me Up.

RESULTS

Close friends and parents provided the most social support and were rated most important, except for teacher informational support. Classmates and schools provided the least social support. Body mass index z-score was correlated with teacher support frequency (r = -.26, p < .05) and minority youth reported more parent support (t(72) = -2.21, p < .05). Compared with other support providers, classmate support significantly predicted most HRQOL scales (p < .001).

CONCLUSIONS

Close friends, parents, and teachers are significant sources of support to youth with obesity; however, classmates play a unique role in the HRQOL of obese youth.

Is obesity associated with emotional and behavioural problems in children? Findings from the Millennium Cohort Study

Objectives. We examined cross-sectional and longitudinal associations between obesity and emotional and behavioural problems in a nationally representative sample of young children. Methods. Data were available from 11 202 children (50% boys) participating in the UK's Millennium Cohort Study. Height and weight were measured at 3 and 5 years and children defined as obese using IOTF cut-offs for body mass index (BMI). Emotional and behavioural problems were parentally assessed using the Strengths and Difficulties Questionnaire. Adjusted linear and multinomial regression analyses were conducted separately for boys and girls. Results. At age 3, obese boys had more conduct problems, and obese girls had more prosocial behaviours, than their normal weight counterparts. At age 5, obese boys had more conduct problems, hyperactivity and inattention problems, peer relationship problems and total difficulties. Obese girls only had more peer relationship problems. Obese 3-year-olds were not at increased risk of abnormal scores; in contrast, obese 5-year-old boys were significantly more likely to have abnormal scores for conduct problems, hyperactivity and inattention problems, peer relationship problems, prosocial behaviours and total difficulties. Obesity, at age 3, was also predictive of peer relationship problems at age 5 in boys (95% CI: 0.26 [0.01, 0.52]). Conclusions. Childhood obesity is associated with emotional and behavioural problems from a very young age. Obese boys are at particular risk. Further research is required to examine effect modifiers and mediating factors in these associations. Recognition and response to these mental health problems should be a goal of pediatric obesity interventions and policies.