Food, Health, & Choices: Curriculum and Wellness Interventions to Decrease Childhood Obesity in Fifth-Graders

Pamela Ann Koch; Isobel R Contento; Heewon L Gray; Marissa Burgermaster; Lorraine Bandelli; Emily Abrams; Jennifer Di Noia

doi:10.1016/j.jneb.2018.12.001

Food, Health, & Choices: Curriculum and Wellness Interventions to Decrease Childhood Obesity in Fifth-Graders

J Nutr Educ Behav. 2019 Apr;51(4):440-455. doi: 10.1016/j.jneb.2018.12.001. Epub 2019 Feb 14.

Authors

Pamela Ann Koch¹, Isobel R Contento², Heewon L Gray³, Marissa Burgermaster⁴, Lorraine Bandelli², Emily Abrams², Jennifer Di Noia⁵

Affiliations

¹ Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY. Electronic address: pak14@tc.columbia.edu.
² Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY.
³ College of Public Health, University of South Florida, FL.
⁴ Department of Nutritional Sciences, Department of Population Health, The University of Texas at Austin, Austin, TX.
⁵ William Paterson University, Wayne, NJ.

PMID: 30772205
DOI: 10.1016/j.jneb.2018.12.001

Abstract

Objective: To evaluate Food, Health, & Choices, two 10-month interventions.

Design: Cluster-randomized, controlled study with 4 groups: curriculum, wellness, curriculum plus wellness, and control.

Setting: Twenty elementary schools (5/group) in New York City.

Participants: Fifth-grade students (n = 1,159). At baseline, 44.6% were at the ≥85th body mass index (BMI) percentile for age and 86% qualified for free or reduced-price lunch.

Intervention: Curriculum was 23 science lessons based on social cognitive and self-determination theories, replacing 2 mandated units. Wellness was classroom food policy and physical activity bouts of Dance Breaks.

Main outcome measures: For obesity, age- and sex-specific BMI percentiles were used (anthropometric measures). The researchers also employed 6 energy balance-related behaviors and 8 theory-based determinants of behavior change (by questionnaire).

Analysis: Pairwise adjusted odds in hierarchical logistic regression models were determined for >85th BMI percentile. Behaviors and theory-based determinants were examined in a 2-level hierarchical linear model with a 2 × 2 design for intervention effects and interactions.

Results: Obesity showed no change. For behaviors, there was a negative curriculum intervention change in physical activity (P = .04). The wellness intervention resulted in positive changes for sweetened beverages frequency (P = .05) and size (P = .006); processed packaged snacks size (P = .01); candy frequency (P = .04); baked good frequency (P = .05); and fast food frequency (P = .003), size (P = .01), and combo meals (P = .002). Theory-based determinants demonstrated no change.

Conclusions and implications: The findings of the lack of a decrease in obesity, behavior changes only for the wellness intervention, and no changes in theory-based determinants warrant further research.

Keywords: elementary school; nutrition education curriculum; obesity prevention; school-based; wellness policy.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Child
Curriculum
Female
Health Promotion / methods*
Humans
Male
New York City
Nutrition Policy
Pediatric Obesity / prevention & control*
Schools