Intensive Behavioral Weight Management Program

Intensive Behavioral Weight Management Program

OVERVIEW

The Intensive Behavioral Weight Management Program is a school-based fitness program for middle-school students. This 24-week curriculum occurs during the school day. The program emphasizes proper nutrition to reduce weight, and includes physical activity. The goal is to maintain a healthy lifestyle throughout life to prevent diseases correlated with overweight, such as type-2 diabetes and cardiovascular disease. For a subsample of Mexican-American children who are overweight, impacts were found on BMI and body fat percentage, but not on blood pressure, cholesterol, or blood-levels of glucose or insulin.

DESCRIPTION OF PROGRAM

Target Population: middle-school students

The no-fee Intensive Behavioral Weight Management Program focuses on maintaining a healthy lifestyle, primarily by adopting healthy eating habits to reduce weight and body fat percentage, and to prevent adult health problems, such as type-2 diabetes and cardiovascular disease, among Mexican-American children. Children are also taught to self-monitor and to set goals. The program is intended for children of any weight. In addition to receiving nutrition education, children participate in sports and other physically active games.

An instructor leads 24 weeks of sessions. Physical activity and nutrition undergraduate students serve as instructors, and those particularly trained in nutrition lead the sessions on that topic. The first 12 weeks have one session daily, Monday through Friday, with one indoor nutrition lesson and four outdoor physical activity lessons per week. In the he second 12 weeks sessions decreases to bi-weekly, on the same Monday through Friday schedule. Sessions last from 35 to 40 minutes, taking place as the last period of the school day. Parents are encouraged to be involved through monthly meetings that teach them how to make changes to family meals, and share activities that promote better nutrition, fewer calories, and more physical activity.

In the nutrition part of the intervention, children are taught to read food labels and to control portion sizes. They next learn to group foods into three categories: safety, caution, and danger. “Safety” foods can be eaten in most quantities, because they are safe for one’s health. They include most fruits and non-starchy vegetables. “Caution” foods should be eaten in moderation, and include low-fat meat, low-fat dairy, and starches. “Danger” foods can be unsafe for one’s health if consumed in excess, and consist of foods with greater than five grams of fat or 15 grams of sugar per serving. Instructors give quizzes on these concepts, and children who miss sessions or do poorly on quizzes are given extra one-on-one help.

For the physical activity part of the program, children start out with a combination of aerobics and resistance training, to build endurance, strength, and flexibility. This primarily involves fitness drills, sports, and learning about monitoring one’s heart rate to tailor an exercise to one’s current fitness level. Weeks seven through 12 focus on skill-building for sports available in the community--for example, neighborhood or school teams.

Children receive points for participation, such as trying new fruits or vegetables, moving continuously during physical activity, and for meeting goals. They exchange their points for prizes each week. To make the program relevant to the participants, mostly Mexican-American students and their families, individuals talked about their food preferences and learned how to choose healthier ingredients or similar alternatives. In particular, parents were taught how to adapt traditional Mexican-American foods so they had fewer calories. Extended family members were also included in the program.

Johnston, C. A., Tyler, C., McFarlin, B. K., Poston, W. S. C., Haddock, C. K., Reeves, R., et al. (2007). Weight loss in overweight Mexican American children: A randomized, controlled trial. Pediatrics, 120(6), e1450-e1457.

Evaluated Population: The evaluated population was from a middle school in an urban area near Houston, Texas. All students were Mexican-American, and the subpopulation described in this article were overweight, with a standardized body mass index (BMI) of at least the 85^th percentile. The children ranged from ten to 14 years of age, with a mean of 12.4.

Approach: Children were randomly assigned to the intensive behavioral program or a self-help condition. The self-help condition included receiving a book called Trim Kids, and information for both the child and his or her parent. While the treatment-condition children were in their class, the control children were in study hall. Subjects’ data were recorded at three months (for BMI and body fat) and six months, after baseline. Height and weight were directly measured, and BMI, was standardized according to the age-sex tables of the Centers for Disease Control. Percent body fat was assessed by means of a bioelectrical impedance scale, which sends an electrical current through the body to assess its composition. Fasting blood samples were taken: total cholesterol, triglycerides, high-density lipoprotein (HDL, good cholesterol), low-density lipoprotein (LDL, bad cholesterol), insulin, and glucose. Blood pressure was also taken. The authors report change-scores between baseline and three months, as well as between baseline and six months.

Results: Mean standardized BMI for the treatment-group children fell significantly, while it increased for the control-group children. This was observed at both follow-up assessments: at three-months(a decrease of 1.2 points versus an increase of 0.3 points) and at six-months ts (a decreasee of 1 point versus an increase of 1.1 points). Children’s BMI percentile scores showed a similar impact : a decrease of 3.1 versus a rise of 0.2 points, at six months; however, the change at three months was nonsignificant. No impacts were found on body fat percentage at either three or six months.

Between baseline and six months, the rise in total cholesterol was smaller for the treatment group than for the control group: 2.7 versus 21.6 points. Change in LDL, or bad cholesterol, was significantly greater for the control group, where the average reading increased by 9.7 points; among the treatment group, LDL on average decreased by 7.7 points. No significant impacts were found in the change from baseline to six months on blood pressure, HDL, triglycerides, glucose or insulin between the two groups.

Johnston, C. A., Tyler, C., McFarlin, B. K., Poston, W. S. C., Haddock, C. K., Reeves, R., et al. (2010). Effects of a school-based weight maintenance program for Mexican-American children: Results at 2 years. Obesity, 18(3), 542-547.

Evaluated Population: See above.

Approach: See above. However, assessments here were taken one and twoyears after baseline. In addition, body fat was calculated using tricep skinfold thickness rather than with bioelectrical impedance. Because too few people consented to the procedure, data from blood-draw measureswere not usable in the analysis. ;.

Results: Significant differences in change-scores were reported at year one for all physical measures, except height. The treatment group change on average was greater and in a positive direction, compared with the control group change. Weight increased on average by 7.4kg in the control group, and by 3.6kg in the treatment group. Standardized BMI, increased on average by 0.1 point in the control group, and decreased by 0.2 in the treatment group. Mean BMI percentile decreased by 0.6 percentage points in the control group, and by 5.5 points in the treatment group. The percent of children who were overweight increased by 3.6 points in the control group, and decreased by 5.5 points among the treatment group. The tricep skinfold test for body fat showed a 0.8mm increase on average for the control group, and 5.6mm decrease among the treatment group.

The between-group differences in change-scores for height, weight, BMI, or percent overweight from baseline to the two-year follow-up were not significant; however, they were significant for standardized BMI (a 2.1 point increase for the control group, versus a 0.8 point increase for the treatment group), and for BMI percentile (a 0.8-point decrease, versus a 6.8-point decrease).

Among blood-level measures, change-scores from baseline to one year for were significantly different between the two groups for total cholesterol and LDL cholesterol, but not for systolic blood pressure, diastolic blood pressure, resting heart rate, HDL cholesterol, or triglycerides. Total cholesterol increased in the control group by 4.9mg/dl, but decreased by 15.4mg/dl for the treatment group. LDL cholesterol decreased by 2.1mg/dl for the control group, and by 14 mg/dl for the treatment group.

SOURCES FOR MORE INFORMATION

References:

Program categorized in this guide according to the following:

Evaluated participant ages: Mid. Childhood (6-11), Adolescence (12-14)

Program components: School-based, Parent or family component

Measured outcomes: Physical Health

KEYWORDS: Children (3-11), Adolescents (12-17), Middle School, Males and Females (co-ed), Hispanic/Latino, Urban, School-based, Parent Training/Education, Skills Training, Parent/Family Component, Nutrition, Obesity, Other Physical Health.

Program information last updated 11/5/10

		© Child Trends 2004