- Click here for explanation of classification scheme.

(Author’s words)

1. To implement a nutrition and activity program for elementary school children consistent with the guidelines for Healthy People 2000 that can be integrated within the current nutrition and activity programs with existing personnel and with minimal training and additional resources
2. To demonstrate the effectiveness of the nutrition and activity program in: a) modifying the diet in accordance with guidelines for Healthy People 2000 (i.e., lower intakes of fat, cholesterol, sodium, increased intakes of fiber); b) decreasing weight gain in children who are overweight; c) increasing physical fitness; d) increasing the knowledge and awareness of diet in health.
3. To demonstrate that the nutrition and activity program will produce favorable changes in markers of health risk which include body weight, body composition, fitness, blood lipids, hypertension and insulin/glucose
4. To demonstrate that an effective program of nutrition consistent with the guidelines for Healthy People 2000 is received equally or better than the existing nutrition program
5. Demonstrate that a program of nutrition, physical activity and education will impact favorably on the student’s lifestyle away from school by promoting wise food choices and increased voluntary exercise.

• Subjects from grades three to five in two school districts in rural Nebraska who had signed informed assent/consents completed by subjects and parents
• Sub-sample from whom laboratory data was collected; Subjects were only included if they had complete data 
• Subjects who would benefit from an attenuation in obesity: Subjects with a body fat of at least 22%.

Subjects with no signed informed assent/consent, and subjects from the sub-sample with missing data.

• Subjects and parents were required to sign informed assent/consent
• Major data collection for the fall of 1992 and 1993 took place in August, September and October and for the Spring of 1993 and 1994 in April and May
•  Lunches were planned with existing kitchen staff over the summer and modifications were installed in the Fall of the first year (Fall of 1992)
• Nutrition education was delivered in modules using trained, existing classroom teachers
• Eighteen grade-specific modules (nine per year) were developed by the nutrition research staff in conjunction with the teachers from the intervention school
• The existing classroom teachers delivered activities designed to promote energy expenditure and decrease time-off-task.

Dependent Variables Observed difference from pre- to post-intervention

• Physical fitness: One-mile walk/run time
• Nutrition knowledge: Grade-specific test designed by nutrition research staff and modified by classroom teacher
• Spontaneous physical activity: Checklist record of day’s activities performed in 24-hour period prior – transformed into MET level.

A sub-sample of 100 students from both control and intervention schools were recruited for measurements of the following outcome variables:

• Body composition: Hydrostatic weighing, measured height and weight and percent body fat
• Classroom physical activity: SOFIT procedure: Trained researchers observed subject’s amount of moment for 10 second periods during physical education class
• Peak aerobic capacity: Maximal treadmill test
• Blood chemistry: Measured plasma triglycerides, cholesterol, HDL cholesterol, glucose, insulin, iron and ferritin
• Blood pressure: Measured systolic blood pressure and diastolic blood pressure
• Twenty-four-hour energy intake (modified 24-hour diet recall from subject, parents were called to verify response).

Independent Variables

Intervention school: School that received a multi-component program

1. Nutrition education: Components included basic nutrition, the relationship between diet and general health, nutrition for proper growth and development, healthy food choices, snack alternatives, reducing fat in the diet and food safety
2. Modified school lunches (using Lunchpower! Program): Reduced energy, fat and sodium lunch which is consistent with the objectives of Healthy People 2000),
3. Enhanced physical activity: An activity approach which deemphasized team sports and provided exercise and games designed to use large muscle groups for 30 minutes, three times per week.

Control school: No change to existing programs.

Control Variables

Intervention and control subjects were matched for ethnicity, SES and baseline characteristics (grade, height, weight, BMI, mile run).

Statistical Analysis

• Power analysis was used to determine sample sizes
• ANOVA to compare the two groups over time.

• Original sample: 
  • The total number of subjects included from each school was not reported
  • A sub-sample of students were recruited from each school to collect laboratory data (Control N=236; Intervention N=102)
• Actual sample:
  • 64 students from control (27% of original sample) and 44 students from the intervention (43% of original sample)
  • Schools were used to collect laboratory data for aerobic capacity, body composition, blood chemistry and physical activity in physical education class
  • Intervention and control subjects were matched on ethnicity, socioeconomic status and baseline characteristics (grade, height, weight, BMI, mile run)
  • Subjects were third, fourth and fifth graders from two school districts
  • 25 control and 11 intervention subjects had at least a 22% body fat; separate analysis was conducted with this sample
• Withdrawals/Drop-outs: Subjects with incomplete data were excluded
• Location: Rural Nebraska
• Race/Ethnicity: 94.3% to 93.6% White
• SES: 42% and 44% of subjects were eligible for free and reduced priced lunches.

Body Weight and Composition

• No significant differences were found between control and intervention schools at the end of two years for weight, BMI or body fat percent (P<0.05). Note: Percent body fat did not show significant changes; however subjects from both schools showed significant increases in BMI.
• The nutrition and physical activity interventions had little effect on measures of obesity.

Attenuation in Obesity

• Among the subjects with body fat of at least 22%, body weight showed similar increases for both control and intervention schools of 8.4±4.1kg and 9.1±3.2kg, respectively
• Body fat decreased from baseline to the end of year two by 2.7±6.9kg for the control and 2.5±5.9kg for the intervention. These decreases were not significant for within or between school comparisons.
• BMI showed significant increases for these subjects of 1.4±1.7kg per m² and 1.4±1.2kg per m² for control and intervention schools, respectively.

(Author’s words from the discussion)

"The nutrition intervention was successful as judged by the changes in the school lunch program, acceptance of the new lunch program by the students and the nutrition knowledge tests. The physical activity intervention was marginally successful in that only modest changes were evident in the level of physical activity in the classroom. Obesity was unchanged in the intervention school compared to the control school as were all components of metabolic fitness except HDL cholesterol which was greater for the intervention school than the control school. It appears that compensation in both energy intake and physical activity outside of school may be responsible for the lack of differences between the intervention and controls."

Industry:	National Livestock and Meat Board Commodity Group:
University/Hospital:	University of Nebraska-Kearney

• Did not control analysis for normal growth during this two-year period
• Authors did not report sample size
• I question whether this is a true prevention intervention as on page 230 it says “The multi-component approach is recommended for the treatment of obesity…”
• No explanation was given for why obesity was defined as at least 22% body fat.