Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e794-e802 (doi:10.1542/peds.2007-1365)
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ARTICLE

A Policy-Based School Intervention to Prevent Overweight and Obesity

Gary D. Foster, PhDa, Sandy Sherman, EdDb, Kelley E. Borradaile, PhDa, Karen M. Grundy, MA, MSEdc, Stephanie S. Vander Veur, MPHa, Joan Nachmani, MS, CNS, SFNSd, Allison Karpyn, PhDb, Shiriki Kumanyika, PhD, MPHe and Justine Shults, PhDe

a Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania
b The Food Trust, Philadelphia, Pennsylvania
c Department of Clinical Developmental Psychology, Bryn Mawr College, Bryn Mawr, Pennsylvania
d Department of Health, Physical Education, Safety and Sports Administration, School District of Philadelphia, Philadelphia, Pennsylvania
e Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania

BACKGROUND. The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic settings. Schools are ideal settings for population-based interventions to address obesity.

OBJECTIVE. The purpose of this work was to examine the effects of a multicomponent, School Nutrition Policy Initiative on the prevention of overweight (85.0th to 94.9th percentile) and obesity (>95.0th percentile) among children in grades 4 through 6 over a 2-year period.

METHODS. Participants were 1349 students in grades 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with ≥50% of students eligible for free or reduced-price meals. Schools were matched on school size and type of food service and randomly assigned to intervention or control. Students were assessed at baseline and again after 2 years. The School Nutrition Policy Initiative included the following components: school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach.

RESULTS. The incidences of overweight and obesity after 2 years were primary outcomes. The prevalence and remission of overweight and obesity, BMI z score, total energy and fat intake, fruit and vegetable consumption, body dissatisfaction, and hours of activity and inactivity were secondary outcomes. The intervention resulted in a 50% reduction in the incidence of overweight. Significantly fewer children in the intervention schools (7.5%) than in the control schools (14.9%) became overweight after 2 years. The prevalence of overweight was lower in the intervention schools. No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years.

CONCLUSION. A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grades 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals.

Key Words: children and adolescents • community pediatrics • obesity • population-based studies • school-based program

Abbreviations: SNPI—School Nutrition Policy Initiative • CDC—Centers for Disease Control and Prevention • GEE—generalized estimating equation • MI—multiple imputation • OR—odds ratio • CI—confidence interval

Accepted Aug 30, 2007.