Obesity after school programs

We speculate that the reduced program impact can be partly attributed to lower FitKid program attendance in the third year. Children of this age start developing nonsport interests and hobbies, which inevitably will take them away from PA-oriented programs.

Societal secular trends may have led to changes in PA and diet in control schools. We were advised by our community advisory board and some school principals that having the youth rate their maturation level by viewing drawings that depicted pubic hair and breast development would cause some schools to drop out of the project.

It is important to note that we observed favorable but nonsignificant effects on BMI in the intervention group. There were no significant intervention effects on the cardiometabolic biomarkers e.

This is consistent with findings from other lifestyle intervention studies in nonobese school-aged children. The program impacts became more apparent and consistent with increased attendance in the step 3 analysis. We and others have previously reported similar findings with respect to the dose of PA that produced favorable changes in body composition and fitness in children, without dietary intervention.

Questions may be raised concerning the sustainability and generalizability of the FitKid program. It is important to note that we designed the FitKid project as a research study to determine whether such an after-school program could have favorable effects on fatness and fitness.

Our results suggest that a program that provides a sufficient dose of MVPA, without restriction of energy intake, can enhance body composition and fitness. This study is not able to cast light on the biologic mechanisms underlying this effect. One possibility is that the PA increased total energy expenditure, thereby reducing total body energy content; however, the absence of a significant effect on BMI suggests that an explanation focusing on body composition, rather than body weight, might be more appropriate.

Another possibility is that the mechanical stimulation of the vigorous PA stimulated immature stem cells to preferentially differentiate into lean tissue, rather than fat tissue.

It should be noted that this study did not collect data to assess factors influencing children's participation in the FitKid program. It is possible that the intensive nature of the physical activities may have been unappealing to a substantial proportion of the youth as compared to other activities they might have selected for the after-school hours. These are important questions that need to be addressed to help in the design of future public health interventions.

The next step is to incorporate our results, along with those of other investigators, into health promotion programs that will be optimally effective in enhancing the body composition and fitness of our youth. After-school PA programs can be implemented with staff training using resources that currently are in existence in most communities, while these facilities and equipment in schools are generally underutilized during after-school hours, weekends, holidays, and school breaks.

Successful after-school programs require consistent supervised structure, well-qualified and well-trained staff, and involvement of community partners, and they must be responsive to needs and interests of both participating children and parents. The rebound effect due to program discontinuity during the summer breaks, which has been shown by others, 47 is noteworthy.

This implies that gains achieved in the 9 months of a school year can be lost during the 3 months of summer. Based on self-report, children in both the intervention and control schools stayed inactive during the summer. According to information gathered from our formative study, 30 we speculate that it was most likely the result of lack of access to safe, supervised, and low-cost PA programs in their neighborhoods during summertime.

Several weaknesses limit the internal and external validity of this study. First, we were unable to assess the reasons of discontinuation in FitKid because children were allowed to rejoin the program freely. It was likely that only the most PA-oriented children regularly attended the program over the years and benefited from it. Second, to overcome the transportation barrier, we used school buses to send children home after the program; this was costly and logistically challenging to the school officials, and may be difficult to implement in community programs.

Nonetheless, the results are consistent with those found in other voluntary after-school programs. We did offer snacks through the USDA snack program that might have had a modest and unmeasured effect on diet. There is some evidence that interventions combining PA and dietary modifications are most effective in reducing obesity in children.

If you build it, will they come? We conclude that the FitKid after-school program represents a promising approach to meet the recommended amount of MVPA for prevention of childhood obesity. The FitKid study was a translation study designed to examine what would happen to body composition and fitness if such a program were offered in an after-school setting.

On the other hand, beneficial results were lost during the summer breaks. Although it is not expected that the FitKid program can be adopted in whole by any community or school system, the findings from our study can be informative for researchers and health promotion specialists in formulating their future projects or interventions. For example, research is needed to improve our understanding of how to attract and retain participants in such programs and how to offer such programs through holidays and school breaks in all communities.

It can also be fruitful to replicate the FitKid program in other sustainable after-school settings in the community. Please contact the first author for a copy of the FitKid Intervention Manual and Testing Manual, which provide information on program administration, intervention activities, staff training, and process evaluation. We want to express our appreciation to Dr. Paule Barbeau, Dr. John Hanes, Ms. Janet Thornburg, and Ms. Elizabeth Stewart for their assistance in program implementation, coordination of data collection, data management, and the FitKid schools, teachers, and participants for their participation.

We also want to thank Dr. Tom Baranowski, Dr. Ken Resnicow, and Dr. Alice Yan for their consultation and guidance in the design, implementation, and data analysis of this study. Yin was responsible for the conception and design of the study, drafting of the manuscript, and obtaining funding for the project. Yin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Moore was responsible for acquisition of data, drafting of the manuscript, and administrative support. Johnson was responsible for analysis and interpretation of data, drafting of the manuscript, and technical support. Vernon was responsible for acquisition of data, critical revision of the manuscript for important intellectual content, and administrative support.

Gutin was responsible for the conception and design of the study, drafting of the manuscript, and obtaining funding for the project. No financial disclosures are reported by the authors of this paper. None of the authors has a known conflict of interest, financial or otherwise that would affect the analysis or interpretation of the data presented within this manuscript.

National Center for Biotechnology Information , U. Childhood Obesity. Child Obes. Moore , PhD, 2 Maribeth H. Johnson , MS, 3 Marlo M. Find articles by Zenong Yin. Justin B. Find articles by Justin B. Maribeth H. Find articles by Maribeth H. Marlo M.

Find articles by Marlo M. Find articles by Bernard Gutin. Author information Copyright and License information Disclaimer. Corresponding author.

E-mail: ude. Copyright , Mary Ann Liebert, Inc. This article has been cited by other articles in PMC. Abstract Background Children tend to be sedentary during the after-school hours, and this has deleterious effects on their health.

Methods A cluster randomization design was employed. Trial Registration Clinicaltrials. Introduction A dramatic increase in childhood obesity has been observed in the United States 1 and other developed countries over the last three decades.

Intervention Program Built on our previous research with obese and nonobese youth, 24 — 26 the FitKid after-school program reconstructed the block of time immediately after school when children are likely to engage in sedentary behaviors.

Statistical Analysis Primary analyses were performed following the intent-to-treat ITT principle, in which the intervention status control vs. Results Study Participant Enrollment and Retention Figure 1 shows the flow of the participants at each measurement point, including those recruited in years 2 and 3.

Open in a separate window. Figure 1. Experimental Control Checks and Program Implementation Table 1 displays the characteristics of study participants and sample size included in longitudinal ITT and annual analyses.

Table 1. Table 2. Influence on the Outcome Measures Table 3 shows the means and standard deviations over six measurement points and results of step 1 analyses on the primary and secondary outcome measures as well as the intraclass correlations. Table 3. Figure 2. Figure 3. Discussion To our knowledge, this is the first longitudinal, randomized study with a direct measure of adiposity over six measurement points that examined the effectiveness of an after-school obesity prevention program in a large sample of elementary school children.

Conclusions We conclude that the FitKid after-school program represents a promising approach to meet the recommended amount of MVPA for prevention of childhood obesity. Notes Please contact the first author for a copy of the FitKid Intervention Manual and Testing Manual, which provide information on program administration, intervention activities, staff training, and process evaluation.

Acknowledgments We want to express our appreciation to Dr. Author Disclosure Statement No financial disclosures are reported by the authors of this paper. References 1. Ogden CL. Carroll MD. Curtin LR, et al. Prevalence of high body mass index in US children and adolescents, — Middelkoop BJC, et al.

Arch Dis Child. Temple JL. Giacomelli AM. Kent KM, et al. Television watching increases motivated responding for food and energy intake in children. Am J Clin Nutr. Blass E. Anderson D. Kirkorian H, et al. On the road to obesity: Television viewing increases intake of high-density foods. Physiol Behav. Moore JB. Schneider L.

Lazorick S, et al. Rationale and development of the Move More North Carolina: Recommended standards for after-school physical activity.

J Public Health Manag Pract. Molnar BE. Gortmaker SL. Bull FC, et al. Austin is also supported by training grants no. Corresponding Author: Erica L. Telephone: E-mail: ekenney hsph. Abbreviation: SD, standard deviation. Abbreviations: BMI, body mass index. What do you think are the top three health concerns for your student population? Choose from list below. What is the approximate proportion of students in your school who are overweight or obese?

What is the approximate proportion of students in your school who you think might have eating disorders? Which grades at your school have school-based wellness or obesity prevention programs? If yes to Q7 Does your school have a packaged or predeveloped school-based wellness or obesity prevention program s? If yes to Q7 Does your school offer wellness or obesity prevention programs developed by you or others at the school?

If yes to Q7 Who was involved in the process of selecting or developing wellness or obesity prevention programs currently offered at your school? If yes to Q7 How did you or others select the school-based wellness or obesity prevention program s currently offered at your school? Please check all that apply. If yes to Q7 How successful do you feel your school-based wellness or obesity prevention program s has been? If yes to Q7 On average, how do you think the wellness or obesity prevention programs currently offered by your school are impacting students in the following areas response options: none, neutral, positive :.

If yes to Q7 Do you think the school-based wellness or obesity prevention programs currently offered by your school have increased, decreased, or had no impact on the following response options: increased, no impact, decreased :.

If yes to Q7 How have you evaluated the success of your school-based wellness or obesity prevention program s? If you do not currently have any school-based wellness or obesity prevention programs, then what factors have impacted the decision not to have these types of programs? The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.

Skip directly to site content Skip directly to page options Skip directly to A-Z link. Preventing Chronic Disease. Section Navigation. Facebook Twitter LinkedIn Syndicate. Minus Related Pages. Erica L. Lee, ScD 1 ; S.

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You will be subject to the destination website's privacy policy when you follow the link. CDC is not responsible for Section compliance accessibility on other federal or private website. Cancel Continue. Lessons were based on the Traffic Light Diet. Results indicated improvement in children's reports of their eating habits. Activity levels improved in 1 school, but not in the other. Parents and children were satisfied with the program and children demonstrated good knowledge of the interventions to promote healthy eating.