Recommendations from overweight youth regarding school-based weight control programs

Adolescents’ Attitudes About Obesity and What They Want in Obesity Prevention Programs

Obesity is a major pediatric public health problem. Adolescents are a priority population for intervention strategies. School nurses are in key positions to design intervention strategies to promote healthy lifestyles and prevent adolescent obesity in the students they serve. To design effective programs, school nurses need to know what components their students perceive as important. This study involved the development and administration of a questionnaire to middle school students to determine their attitudes about overweight/obesity and what they felt would work for them. Adolescents are willing to exercise more, to change eating habits to include more fruits and vegetables, drink more water, and eat less junk food. They are not willing to give up soda, video/computer games, and watching television to improve their health. School nurses can use this questionnaire to collect data that will assist in the development of effective programs for their students.

New moves-preventing weight-related problems in adolescent girls a group-randomized study

BACKGROUND

Weight-related problems are prevalent in adolescent girls.

PURPOSE

To evaluate New Moves, a school-based program aimed at preventing weight-related problems in adolescent girls.

DESIGN

School-based group-randomized controlled design.

SETTING/PARTICIPANTS

356 girls (mean age=15.8±1.2 years) from six intervention and six control high schools. More than 75% of the girls were racial/ethnic minorities and 46% were overweight or obese. Data were collected in 2007-2009 and analyzed in 2009-2010.

INTERVENTION

An all-girls physical education class, supplemented with nutrition and self-empowerment components, individual sessions using motivational interviewing, lunch meetings, and parent outreach.

MAIN OUTCOME MEASURES

Percentage body fat, BMI, physical activity, sedentary activity, dietary intake, eating patterns, unhealthy weight control behaviors, and body/self-image.

RESULTS

New Moves did not lead to significant changes in the girls' percentage body fat or BMI but improvements were seen for sedentary activity, eating patterns, unhealthy weight control behaviors, and body/self-image. For example, in comparison to control girls, at 9-month follow-up, intervention girls decreased their sedentary behaviors by approximately one 30-minute block a day (p=0.050); girls increased their portion control behaviors (p=0.014); the percentage of girls using unhealthy weight control behaviors decreased by 13.7% (p=0.021); and improvements were seen in body image (p=0.045) and self-worth (p=0.031). Additionally, intervention girls reported more support by friends, teachers, and families for healthy eating and physical activity.

CONCLUSIONS

New Moves provides a model for addressing the broad spectrum of weight-related problems among adolescent girls. Further work is needed to enhance the effectiveness of interventions to improve weight status of youth.

Health behavior interests of adolescents with unhealthy diet and exercise: implications for weight management

This study sought to determine individual factors that may influence adolescents' interests in various health behaviors and, by extension, their potential interest in programs that promote healthy lifestyles and reduce obesity. The sample consisted of 737 rural Pennsylvania (United States) middle and high school students not involved in either healthy exercise or dietary behaviors (a target group for health-promoting interventions). Participants completed a self-report measure of their general health functioning, including their interests in sports programs, outdoor recreation programs, weightlifting, weight loss and healthy eating/cooking. Nurses measured body mass indices (BMIs). The vast majority of the sample endorsed self-efficacy in healthy eating and physical activity, and this self-efficacy was associated with interest in a healthy diet and outdoor recreation. Interest in healthy activities was consistently higher among 7th graders (age mean = 12.6 years) than 11th graders (age mean = 16.3 years). Females were more interested in weight loss and healthy eating/cooking, whereas males were more interested in weightlifting. Higher BMI only predicted interest in weight loss. These results indicate that adolescent health interests vary on the basis of their gender, grade level, BMI and self-efficacy. These trends are potentially important to consider when seeking to match intervention programs to adolescent interests.

Scale development for perceived school climate for girls' physical activity

OBJECTIVES

To test an original scale assessing perceived school climate for girls' physical activity in middle school girls.

METHODS

Confirmatory factor analysis (CFA) and structural equation modeling (SEM).

RESULTS

CFA retained 5 of 14 original items. A model with 2 correlated factors, perceptions about teachers' and boys' behaviors, respectively, fit the data well in both sixth and eighth graders. SEM detected a positive, significant direct association of the teacher factor, but not the boy factor, with girls' self-reported physical activity.

CONCLUSIONS

School climate for girls' physical activity is a measurable construct, and preliminary evidence suggests a relationship with physical activity.

New Moves: a school-based obesity prevention program for adolescent girls

BACKGROUND

This study tests the feasibility of an innovative school-based program for obesity prevention among adolescent girls. New Moves was implemented as a multicomponent, girls-only, high-school physical education class.

METHODS

Six schools were equally randomized into intervention and control conditions. Data were collected at baseline, postintervention, and 8-month follow-up to assess program impact on physical activity, eating patterns, self-perceptions, and body mass index (BMI) among 89 girls in the intervention and 112 girls in the control conditions. Program evaluation also included interviews with school staff, parent surveys, and participant interviews and process evaluation surveys.

RESULTS

The feasibility of implementing New Moves was high, as indicated by strong satisfaction among participants, parents, and school staff, and by program sustainability. Participants perceived a positive program impact on their physical activity, eating patterns, and self-image. Girls in the intervention significantly progressed in their stage of behavioral change for physical activity from baseline to follow-up. However, for the majority of outcome variables, differences between intervention and control schools at postintervention and follow-up were not statistically significant.

CONCLUSIONS

New Moves was well received and fills a needed niche within school physical education programs. An expanded intervention and evaluation is needed to enhance and assess long-term program effectiveness.

Integrating the prevention of eating disorders and obesity: feasible or futile?

The rate of obesity in adults and youth has doubled in the past 20 years; during this same period there has been an increase in the prevalence of "dysfunctional eating behaviors," including eating disorders and unhealthy weight loss practices. Despite the fact that obesity, eating disorders, and unhealthy weight loss practices are cultivated in the same cultural context-an increasingly "toxic" environment regarding food and weight-these problems are regarded as distinct, with different origins, courses, and approaches to prevention and treatment. In this article, we present conceptual and practical reasons for adopting an integrated approach to the prevention of the spectrum of problems related to eating and weight (i.e., eating disorders, obesity, and unhealthy weight loss practices), suggest personal, socioenvironmental, and behavioral factors to be included in an integrated approach to prevention, and provide some ideas for developing an integrated program using a media literacy/advocacy approach. We conclude with a discussion of challenges to the development of interventions aimed at the broad spectrum of weight-related problems and suggestions for addressing these challenges.

Effects of socioeconomic status on the obesity knowledge of adolescents from six Latin American cities

OBJECTIVE

To examine the effects of socioeconomic status (SES) on the obesity knowledge of adolescents in six Latin American cities.

DESIGN

Data were collected using an anonymous, self-administered questionnaire consisting of demographic questions and a 25-item multiple-choice obesity knowledge test. Test items were clustered under five topics: the fat and calorie content of foods and beverages; weight loss methods; energy expenditure; food preparation methods; and the relationship between obesity and health.

SUBJECTS

A total of 1272 ninth grade students from higher and lower SES families were recruited at schools in Buenos Aires, Argentina (n=195); Guatemala City, Guatemala (n=212); Havana, Cuba (n=213); Lima, Peru (n=218); Panama City, Panama (n=195); and Santiago, Chile (n=239).

RESULTS

Mean test scores reflected a low level of obesity knowledge among adolescents from higher and lower SES groups in all six cities. Nevertheless, a trend for higher scores emerged in favor of adolescents from wealthier families. This income effect persisted after controlling for gender and weight status. The weakest knowledge areas among youth from the higher SES groups were food preparation methods and the relationship between obesity and health while those for adolescents from the lower SES groups were the fat and calorie content of foods and beverages and the relationship between obesity and health. Classroom instruction about obesity was generally more available to students from the higher SES groups. The majority of adolescents from both SES groups were interested in learning more about weight loss methods, energy expenditure, and the fat and calorie content of foods and beverages. The topic of least interest was the relationship between obesity and health.

CONCLUSION

These preliminary findings suggest a need for more obesity education programs for adolescents, especially for those living in poverty.

School-based programs for obesity prevention: what do adolescents recommend?

Twenty-five focus groups conducted with 203 adolescent boys and girls from junior high and high schools in St. Paul, Minnesota, showed that students want weight control programs that are fun, interactive, accessible, convenient, low in cost, sensitive to the needs of adolescents, include multiple physical activity options, and are offered to all students, regardless of their weight.

A coordinated school health program approach to adolescent obesity

Obesity has become one of this country's most significant nutritional diseases. The prevalence of childhood and adolescent obesity has steadily increased over the past 20 years. The risk of developing health problems increases as the obese child becomes an obese adolescent and adult. The 1997 Youth Risk Behavior Survey reports adolescents participate in behaviors that put them at risk for obesity. The recognition of these unhealthy behaviors among our youth has led to the need for early intervention. The Coordinated School Health Program is a mechanism to address adolescent obesity at the school-age level. This program includes an organized set of policies, procedures, and activities intended to protect and promote the health and well-being of students and staff. The eight components of a Coordinated School Health Program (CSHP) include school health services, a healthy school environment, comprehensive school health education, counseling and guidance, physical education, food service, worksite health promotion, and the integration of school and community. This paper describes integration of prevention and treatment strategies for adolescent obesity for each of the eight components of a CSHP.