School-based childhood obesity prevention programs prove successful

Jan. 23, 2014


BLOOMINGTON, Ind. -- A study by researchers from Indiana University’s Indiana Institute on Disability and Community and Ewha Womans University, Seoul, South Korea, found that both public and private schools, despite some variability, could successfully implement programs designed to reduce the percentages of overweight children and modify their dietary habits, physical activities and sedentary behaviors.

The rate of childhood obesity has tripled over the past 30 years, and it continues to increase. In 2008, 19.6 percent of children ages 6 to 11 and 18.1 percent of adolescents ages 12 to 19 were obese. Decreasing the prevalence rates of childhood obesity reduces the risk of high cholesterol and blood pressure, lessens several physical and mental health concerns, and diminishes the likelihood of issues related to heart disease, type 2 diabetes and stroke in adulthood.

The HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic, Schools) Initiative study, funded through the Welborn Baptist Foundation, is a multilevel and multiple-year childhood obesity prevention intervention program that focuses on alleviating childhood obesity in Southern Indiana, Northwestern Kentucky and Southeastern Illinois. Those three states have some of the highest obesity rates in the United States, according to the Centers for Disease Control and Prevention.

The study was predicated upon the CDC’s recommended coordinated school health approach and implemented at the school level rather than the more typical district level. This strategy encouraged schools to take ownership over needs assessment, planning and implementation of strategies for school change.

"We have data to suggest that changes in schools' wellness environments are greater when individual schools, rather than entire districts, plan and implement policies and programming based on the needs of their specific students, staff and families," said Mindy Hightower King, principal investigator for the study and an evaluation manager with the Indiana Institute’s Center on Education and Lifelong Learning. "These changes include, but are not limited to, healthier foods available in classrooms, concession stands and fundraisers, as well as opportunities for physical activity outside of dedicated PE classes."

The HEROES Initiative focused on five of eight components of the coordinated school health approach most closely related to the prevention of childhood obesity: health education, physical education, nutrition services, health promotion for staff, and family and community involvement. A supportive infrastructure for participating schools that involved local oversight, funding and prescribed implementation strategies based on schools’ individual needs and identities was also grounded within the initiative’s framework.

Through the fall of 2012, 31 schools had participated in the study, and 13 had completed the three-year funding period. Because the HEROES Initiative evaluation is ongoing, the most recent wave of data collection, from spring 2012, is summarized from 17 participating schools.

HEROES was evaluated through an academic-community partnership using a three-tiered approach of process evaluation and school-level and student-level outcome evaluations. The evaluations addressed key questions related to the coordinated school health framework, how schools change policies and practices, and the extent to which students change their nutrition and physical activity behaviors, and show changes in body mass index.

Findings in the 2013 report include:

  • Process Evaluation Analysis -- Data collected in spring 2012 were used to address implementation fidelity of programs across all years of the intervention. For the HEROES Coordination and Administrative Involvement domains, 15 of the 17 schools (88.2 percent) were implementing with fidelity.
  • School-Level Outcome Evaluation Findings -- Of the five coordinated school health domains, the mean number of indicators for which schools obtained a 2.5 or more was 3.24 with a range of 2 to 5. Generally, schools were able to effectively create changes to the school environment regarding physical education and activity, nutrition education, and family and community involvement.
  • Student-Level Outcome Evaluation Findings -- Student-level outcome data showed small but significant changes in the proportion of overweight students in the first 18 months of the intervention. Positive changes in several nutrition behaviors were also reported. Finally, more students reported engaging in vigorous physical activity following the intervention compared to baseline.

Although many of the findings in this study may appear modest, small change can make an important impact on population-level health outcomes. Despite the challenges that came with implementing a large-scale initiative such as HEROES along with the need for consistent data collation from each evaluation cycle, the findings demonstrated that the HEROES Initiative has been successful in reducing the percentage of overweight children in participating schools and healthfully modifying their dietary, physical activity and sedentary behaviors.

The study also reinforces the notion that school-based programs that include coordinated school health model components have even more potential for success when they are part of a larger scale of interventions that involve other realms of children’s environments such as household, community and media participation.

The Indiana Institute on Disability and Community

The Indiana Institute on Disability and Community, Indiana's University Center for Excellence on Disabilities, works to increase community capacity in disability through academic instruction, research, dissemination and training, and technical assistance.

The Office of the Vice Provost for Research

The Indiana Institute receives support from the Office of the Vice Provost for Research at Indiana University Bloomington, which is dedicated to supporting ongoing faculty research and creative activity, developing new multidisciplinary initiatives and maximizing the potential of faculty to accomplish path-breaking work.

The Welborn Baptist Foundation

The mission of Welborn Baptist Foundation is to apply Christian principles in support of improved community health, well-being and quality of life for all members of the Tri-State community.