Implementing a Multi-Component School-based Obesity Prevention Intervention: A Qualitative Study

Objective: To explore barriers and facilitators to implementing and sustaining Healthy Choices, a three-year multi-component obesity prevention intervention implemented in middle schools in Massachusetts. Methods: Using purposive sampling, 56 in-depth interviews were conducted with middleschool employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses. Results: State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers while staff buy-in and technical assistance were seen as facilitating implementation. Respondents felt that intervention sustainability was dependent on external funding and expert assistance. Conclusions and Implications: Results confirm the importance of gaining faculty and staff support. Schools implementing large scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance

Effect of the Planet Health Intervention on Eating Disorder Symptoms in Massachusetts Middle Schools, 2005–2008

Introduction: The Planet Health obesity prevention curriculum has prevented purging and abuse of diet pills (disordered weight control behavior [DWCB]) in middle-school girls in randomized trials, but the effects of Planet Health on DWCB when implemented by schools under dissemination conditions are not known. Methods: Massachusetts Department of Public Health and Blue Cross Blue Shield of Massachusetts disseminated Planet Health as part of the 3-year, Healthy Choices obesity prevention program in middle schools. We conducted an evaluation in 45 schools from fall 2005 to spring 2008. We gathered data from school staff to quantify intervention activities, and we gathered anonymous cross-sectional survey data from students on DWCB at baseline and Year 3 follow-up (n = 16,369). Multivariate logistic analyses with generalized estimating equations examined the effect of intervention activities on odds of students reporting DWCB at follow-up. Results: Students in schools reaching a high number of youth with Planet Health lessons on reducing television viewing had lower odds of DWCB at follow-up (odds ratio [OR], 0.80 per 100 lesson-exposures; 95% confidence interval [CI], 0.74–0.85). In addition, reduced odds of DWCB at follow-up were found in schools with active staff teamwork (OR, 0.76; 95% CI, 0.66–0.86) and the presence of programs addressing television viewing goals with staff (OR, 0.38; 95% CI, 0.28–0.53). Conclusion: Combined evidence from efficacy and effectiveness trials and now from dissemination research indicates that appropriately designed obesity prevention programs can achieve DWCB prevention on a large scale

Effect of the planet health intervention on eating disorder symptoms in Massachusetts middle schools, 2005-2008

INTRODUCTION: The Planet Health obesity prevention curriculum has prevented purging and abuse of diet pills (disordered weight control behavior [DWCB]) in middle-school girls in randomized trials, but the effects of Planet Health on DWCB when implemented by schools under dissemination conditions are not known. METHODS: Massachusetts Department of Public Health and Blue Cross Blue Shield of Massachusetts disseminated Planet Health as part of the 3-year, Healthy Choices obesity prevention program in middle schools. We conducted an evaluation in 45 schools from fall 2005 to spring 2008. We gathered data from school staff to quantify intervention activities, and we gathered anonymous cross-sectional survey data from students on DWCB at baseline and Year 3 follow-up (n = 16,369). Multivariate logistic analyses with generalized estimating equations examined the effect of intervention activities on odds of students reporting DWCB at follow-up. RESULTS: Students in schools reaching a high number of youth with Planet Health lessons on reducing television viewing had lower odds of DWCB at follow-up (odds ratio [OR], 0.80 per 100 lesson-exposures; 95% confidence interval [CI], 0.74-0.85). In addition, reduced odds of DWCB at follow-up were found in schools with active staff teamwork (OR, 0.76; 95% CI, 0.66-0.86) and the presence of programs addressing television viewing goals with staff (OR, 0.38; 95% CI, 0.28-0.53). CONCLUSION: Combined evidence from efficacy and effectiveness trials and now from dissemination research indicates that appropriately designed obesity prevention programs can achieve DWCB prevention on a large scale

Dietary and Physical Activity Factors Related to Eating Disorder Symptoms Among Middle School Youth

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95371/1/j.1746-1561.2012.00742.x.pd

Change in leptin, body composition and other hormones around menarche--a visual representation

AIM: To present a visual representation of changes in body composition, leptin, insulin, estradiol and follicular stimulating hormone (FSH) levels in relation to menarche in girls. METHODS: Participants were a subset of healthy girls (n = 108) enrolled in a longitudinal study of growth and development conducted at the General Clinical Research Center at the Massachusetts Institute of Technology (MIT). Participants were seen annually from before menarche until 4 years postmenarche for measures of body composition and serum levels of leptin, insulin, estradiol and FSH. Body composition was determined by bioelectrical impedance. Standardized body composition and hormone levels were smoothed and plotted relative to menarche to visualize patterns of change. RESULTS: At menarche, the mean percentage body fat (%BF) of girls was 24.6% (SD = 4.1%) after menarche %BF was approximately 27%. Leptin levels averaged 8.4 ng/mL (SD = 4.6) at menarche and were approximately 12 ng/mL after menarche. Changes in leptin levels closely paralleled changes in %BF. Insulin, estradiol and FSH levels followed expected patterns relative to menarche. Leptin began rising closer to menarche than did insulin or the other sex hormones. Conclusion: We provide a visual presentation of hormonal and body composition changes occurring throughout the pubertal period in girls which may be useful in generating new hypotheses related to the timing of menarche

Longitudinal changes in the accuracy of reported energy intake in girls 10-15 y of age

BACKGROUND: Dietary records are often used to estimate individual energy needs and population energy requirements. However, significant underreporting of total energy intake (EI) has been found when EI is compared with total energy expenditure (EE) measured by doubly labeled water. OBJECTIVE: This study aimed to determine whether the accuracy of reported EI decreases from middle childhood to adolescence. DESIGN: In this longitudinal study of 26 healthy girls, EI and EE were measured at ages 10, 12, and 15 y. Accuracy of reported EI (EI/EE x 100%) was calculated at each age. At study entry, girls had a mean (+/- SD) body mass index (in kg/m(2)) of 16.8 +/- 1.9 and percentage body fat of 24.0 +/- 4.6%. Measurements of EI were a 7-d dietary record and those of EE were by doubly labeled water. RESULTS: As they got older, girls tended to report EI less accurately: the average accuracy was 88 +/- 13% at age 10 y, 77 +/- 21% at age 12 y, and 68 +/- 17% at age 15 y. The declines in reporting accuracy from age 10 y to age 12 y and from age 10 y to age 15 y were statistically significant (P = 0.03 and P = 0.001, respectively). Reporting accuracy also declined from age 12 to age 15 y but not significantly. When percentage body fat was added to the model, results were essentially unchanged. CONCLUSION: Because of the decline in EI reporting accuracy with age, the use of EI data obtained from dietary records in adolescent girls will result in substantial underestimation of energy needs

Racial/ethnic and weight status disparities in dieting and disordered weight control behaviors among early adolescents

Background This study examined whether racial/ethnic minority early adolescents with overweight/obesity are at increased risk of disordered weight control behaviors, defined as unhealthy behaviors aiming to control or modify shape and weight, ranging from self-induced vomiting to the use of dietary supplements. Methods U.S. Middle school children (n = 12.511) provided self-report of gender, race/ethnicity, height, and weight as well as dieting and disordered weight control behaviors. Results In the entire sample, 25.6% (n = 1514) of girls and 16.6% (n = 1098) of boys reported dieting within the last month, while 3.5% (n = 200) of girls and 2.7% (n = 176) of boys reported DWCB. Within all racial/ethnic groups, participants classified as being overweight/obese (34% to 50%) were more likely to report dieting compared to their counterparts without overweight/obesity (9.6% to 29.6%). Racial/ethnic minority children with overweight/obesity had an increased risk of dieting and disordered weight control behaviors compared to their counterparts without overweight/obesity, and, for some outcomes, compared to their White peers with overweight/obesity. Conclusions Racial/ethnic minority early adolescents with overweight/obesity are a particularly vulnerable group for disordered eating

Family physical activity and meal practices associated with disordered weight control behaviors in a multiethnic sample of middle-school youth

OBJECTIVE: Family practices around weight-related behaviors can shape children\u27s development of disordered weight control behaviors (DWCB), such as vomiting, taking laxatives, or taking diet pills without a prescription. This study examined family meal and physical activity (PA) practices associated with DWCB among a multiethnic sample of youth. METHODS: We assessed self-report data on frequency of family sit-down dinners, types of parental involvement in their children\u27s PA, and DWCB are from 15,461 6th to 8th grade girls and boys in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). RESULTS: Youth who had family sit-down dinners every day had lower odds of DWCB (girls: odds ratio [OR] 0.3; 95% confidence interval [CI] 0.2-0.5; boys: OR 0.6; 95% CI 0.4-0.9) than youth who never had family sit-down dinners. Similar effect estimates were found for youth who had family sit-down dinners most days. Parental provision of rides to and from a PA event was also found to be protective against DWCB among girls (OR 0.7; 95% CI 0.5-0.9). In contrast, parental participation in PA with their children was associated with increased risk for DWCB (girls: OR 1.4; 95% CI 1.0-1.8; boys: OR 1.9; 95% CI 1.4-2.4). These associations did not differ by race/ethnicity or weight status. CONCLUSIONS: Programs emphasizing the importance of family meals may be beneficial in preventing DWCB in youth of all ethnicities. Further research is needed on how various methods of parental involvement in their children\u27s PA are associated with DWCB. rights reserved

Middle school food environments and racial/ethnic differences in sugar-sweetened beverage consumption: findings from the Healthy Choices study

BACKGROUND: Prior studies have demonstrated disproportionate clustering of fast food outlets around schools. PURPOSE: The purpose of this study is to determine if racial/ethnic differences in middle school student self-reported sugar-sweetened beverage (SSB) consumption is explained by differential distributions of food outlets surrounding their schools. METHODS: Baseline (2005) data were analyzed from 18,281 middle school students in 47 Massachusetts schools participating in Healthy Choices, an obesity prevention program. Linear mixed effects models were used to examine the association of individual race/ethnicity and daily SSB consumption and the potential mediating effect of the density of food outlets (the number of fast food outlets and convenience stores in a 1500 m buffer area surrounding the school) on this association adjusting for individual and school demographics. RESULTS: More SSB consumption was reported by students of all racial/ethnic minority groups compared to their White peers except Asians. The density of fast food restaurants and convenience stores was not associated with individual SSB consumption (beta=0.001, p=0.875) nor did it mediate the association of race/ethnicity and SSB consumption. CONCLUSIONS: Racial and ethnic differences in SSB consumption among MA middle school students cannot be fully explained by the location of fast food restaurants and convenience stores