Thursday, December 12, 2013

Transformative Education for Long-Term Behavior Change: Preventing Childhood Obesity and Improving Health through In-School Curriculum-based Nutrition and Exercise Programs

Scott Turne, Fielding's School of Human & Organizational Development

Background: Nearly half of obesity cases begin in childhood, with 80% persisting into adulthood. This highlights a compelling need to improve child obesity (CO) prevention programs. In-school programs, which are multicomponent, structured, rigorous, long-lasting, and include parents are particularly effective. Nevertheless, longer term impact is poorly understood.

Methods: This study used a curriculum design theory lens to evaluate the long-term impact among middle school students of elementary school childhood obesity prevention programs, by focusing on Operation Tone-Up®(OTU). OTU has been implemented for over 10 years in lower income elementary schools in many states, and has positive, material, short-term outcomes. A mixed methods, retrospective, quasi-randomized, longitudinal study was conducted, controlling for sex, socioeconomic status (SES),ethnicity, grade level, and other factors. Three hundred seventy (370) predominantly Hispanic, lower income students in grades 6-8 in Maricopa County, Arizona were surveyed in May 2012 about their past participation in OTU and their current nutrition and physical activity (PA) knowledge, attitudes, and behaviors.

Results: The intervention had significant effects on health outcomes, although these effects declined during the years after participation. Students in grades 6-8, who had participated in OTU in elementary school, had significantly healthier nutrition knowledge than control students (β = 0.831, p = .013, odds ratio = 2.295), and had healthier nutrition attitudes and nutrition behavior. Intervention students were significantly more likely to report high PA behavior (β = 0.798, p = .028, odds ratio = 2.221). In addition, girls in the intervention group reported significant, much healthier PA than girls in the control group. Intervention participation helped to increase the healthy behavior of lower income, female, and Hispanic populations.

Conclusions: The study showed that effective anti-obesity interventions can have significant positive short-term impacts on children, but their effects decline over the long-term. Ideally, maintenance should occur over many years by continuous “spiral learning” reinforcement and increasing school time spent on effective health and physical education (HE; PE). At the same time, HE and PE should be made more effective at improving behavior outcomes. HE and PE should also be integrated into the core preK-12 school curriculum, standards, and tests in order to maximize long-term follow-through and impact. The CO prevention movement should also use curriculum theory and HE and PE associations with increased academic performance to help bridge the gap between health educators and school leaders.

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