Program

Nov 05, 2010

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 85th 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:

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.

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

Subscribe to Child Trends

Short weekly updates of recent research on children and youth.