HUN 3800

School Based Intervention Programs and Childhood Obesity

Lucas Duran

N01045927

10/28/2016
 School Intervention Programs and Childhood Obesity
How effective are schools in implementing the prevention of childhood obesity? I mean in regard

to this topic the most whole-rounded question to ask that Ive thought about can be summarized by

the following; Does regulating and monitoring diets for all children in school kindergarten through

12th grade create healthier diet awareness subsequently lowering the obesity population? We must

first ask ourselves multiple exclusive questions to discuss and make an interpretation whether or not

methodologies now are effective in school and at home. Secondly, what do food and macronutrient

intake levels among our young ones tell us as a result. Thirdly, in the midst of a childs life we must

then ask ourselves what psychological factors influence decision making when it comes to dietary

selection at school, home, and anywhere a child can hypothetically be. Finally, considerations need

to be made in what nutrition guidelines are taught in school and promoted by adults. These results

can indicate healthier applications to practice that maybe yield more results as an overall percentage

of lowering the obesity prevalence in our youth. Over the last thirty years we as a nation have

witnessed childhood obesity in six to eleven year old individuals grow from seven percent nationally

to a whopping eighteen percent just a few years ago (this doesnt even include older minors as well,

being is how over thirty percent of our children from age two to nineteen fall under the obese

category) [1]. There are so many potentially threatening health repercussions that can or will occur if

effective intervention strategies are not implemented and analyzing whether or not monitoring and

recording individual diets actually works. Does it instill diet discipline among the child at a young

age, enough-so that they fall out of the obese category? In a closing introductory thought, that would

be the ultimate goal trying to create awareness to the point of the child not falling under the

previously mentioned statistic. Below is a compilation of research in this regard and a summary for

what it might mean.

Intervention Methodologies
 After analyzing multiple research statistics and verifying their credibility for the information they

contain multiple intervention strategies were implemented at school, home, after-school care, and other

places for the duration of the research Im referring to (over the last thirty years, concentrating on the

last decade). After analyzing many resources it is imperative to consider all settings in this category to

grasp a complete understanding of reasoning that constitutes obesity contributing causes. In the

intervention strategies implemented within parents daily lives at home with their children evidence

proved to be very effective. Body mass index percentages decreased significantly, waist circumference

lowered, and a decrease in television viewing all were among proven statistics. To understand if school

programs and interventions are successful you must first understand the ones that seem to work at home.

The interventions that took place were produced by a parent training program that assisted adults with

the knowledge of instilling and promoting healthy eating, physical activity, and decreasing sedentary

behaviors in the home environment [1]. Understanding that in order to be more successful at these

intervention programs starting with implementation at home would yield a more positive flow of results

according to my sources. Data revealed that more educated and knowledgeable parents and guardians

concluded with more success and a decrease in obesity percentage was prevalent in children.

The next part of this research incorporates a much more extensive analysis into about three times

as many studies and programs that have currently and in the past been used to promote the use of

intervention programs in our school system. After complete review it was somewhat shocking to

discover that not many of these interventions included the use of recording and analyzing diet specifics

child-to-child. Results indicated that there was much error involved in consistently recording diets

every-day (over thirty five percent) [2]. Many of the school-based interventions included strategies that

didnt record dietary intakes but focused on nutrition education programs with physical activity

components. A general way this type of intervention can be summarized involves much verbal and re-

directive influence that gives the child more of an opportunity to increase independence and utilize the

tools provided that outline what is too much and staying in a general range of moderation. Much of the
research revealed how many errors can potentially be associated with trying to record and monitor every

aspect of a childs diet. The amount of discipline involved with having to keep up with our own diet let

alone a childs (that is constantly changing) is a lot for someone to take on especially parents and school

teachers. Results revealed that high error margins in regards to portions being able to be recognized and

recorded with accuracy showed that a response rate to even complete a general food consumption

observation became as low as 48% and reveals that this number drastically decreases from the time

theyre one year old to around thirteen years old [2]. The previous mentioned results are only associated

with a three-day complete food journal so you can imagine the amount of success yielded from doing it

all the time. Newer resources similar to choosemyplate.gov allow for dietary records to be recorded and

observed much easier than before making an app and navigation very simple for its use. It also indicates

that according to the statistics related to this on my second reference consistently recording dietary

intakes by higher income/educated parents resulted in better participation. This fact answers my

previous statement regarding parent participation and how incredibly important it is in conjunction with

school based interventions. Statistics aligned with this are very accurate showing that parental

involvement drastically increases the chance of a child growing up and not becoming obese. Research

methods for facts stated above include descriptive statistics of a controlled main idea or variable that

resulted with the review having a ninety five percent confidence interval.

Food and Macronutrient Intakes

One could argue what and why the availability of specific macronutrients is a direct

contributor of adolescent obesity. To put it in perspective, when is the last time you witnessed many

healthy options being offered in the majority of public schools. If you take a look inside our public

school system (this is more or less the population were referring to) it is prevalent that foods are low

in dietary fat and loaded with added sugars. If you look a little deeper in this regard youll notice that

its more than that, they are given options to choose from but more often than not results without

general target moderations considered. We here that all the time, moderation and portions with much

emphasis and the majority of the studies revealed in more ways thsn one that this was the biggest
challenge. Data has concluded with confidently assuming diet quality decreases with age [2]. This

allows transitioning into another very important question, what are our children slowly becoming

exposed to that allows a steady percent increase as a result from the previous statement. One could

argue school would be a major contributor but extensive research leans toward a combination of

things not any direct cause specifically. These factors include home life, school life, and also food

types and there availabilities. Over the years Ive witnessed and read multiple times about the

attempts from schools to ban soft drink sales at school or on school property. You dont have to read

any statistic to be able to understand how effective this has been. Many school campuses elementary

through high school have been unsuccessful at removing mostly vending machines with high fat

snack machines [3]. Body mass index charts refer to increases being associated with children from

ages 2 months old all the way up to seven years old [2]. From that point on charts reveal obesity

rates decrease at that point in life. With that being said what are the most consumed liquid and solids

from the above listed age groups? Data analysis reveals milk is the overall highest percent liquid

consumed at age five years old and seven with diet (artificially sweetened beverages) soda coming in

at number two [2,3]. This information can be directly correlated from home-life as well with little

error, taking into account habits and other psychological factors that directly influence obesity

outcomes start at home. If something is available for consumption at the early years you can

hypothesize the odds of a frequent soda habit are likely to continue on through school and later on

through life according to all but one of the listed references. Much of effective intervention has

shown reduced added sugar intakes that can directly be aligned with a reduced prevalence of obesity.

The CDC reported in 2009 that overweight two to five year olds percentile had grown from five

percent to almost thirteen percent [4], how much of that can be linked to soda beverage habits and

other often consumed added sugar beverages.

Dietary Psychology

Psychologically many stimuli affect and make up the perspective of a child in regards to many

things, very specifically the diet. Assuming a combination of genetic influences are involved from
the parents many things are considered psychosocial and can result in habits or impulses that dictate

decision making. Excessive caloric intake, insufficient physical activity and sleep deprivation are all

major factors involved in the development of childhood obesity [6]. Psychologically these all take a

toll on a child especially in the early stages of life. Recognizing and implementing interventions at a

young age can account for a healthier path going forward. Much can be questioned about what can

constitute stress in a childs life. School can be outlined as a major one, they are constantly being

exposed in environments that potentially make them uncomfortable or impulsively react to make

dietary selections that are not aligned with recommendations. For instance, in a cross sectional study

completed observations accounted for childhood stress accounting for what we as Americans

recognize as binge eating. Certain situations can prompt us to instinctively eat or not eat depending

on what is taking place around us. Foods high in added sugars and fat have forever been referenced

as comfort foods and psychosocial stress is said to promote the consumption of these [6]. An

example for instance, a child at home growing up with a normal life can witness this occurring for

one or both parents simultaneously triggering the same thing to occur in themselves. The above

mentioned study also factors in secreted cortisol levels triggered at the time of analysis to attempt at

considering all factors. Among the participants tested high caloric snacking was listed as the most

common regression as a result of the high stress environment some of these children were exposed

to. Some of the studies that I read outlined what seemed to be the most effective form of redirection

that included diet monitoring involving the adult as well. Among all of the completed ones viewed

the highest success rate of obesity lowering intervention came from participation from the parents as

well as the child. When discussing decision making that results from what a child does it is

important to keep in mind that all children in development are going through metabolic and

hormonal changes constantly from the time they are born all the way into adulthood. Considering

this and implementing modified intervention to assist that are targeted to help them specifically is

something I have not witnessed reading through my sources. Interventions that were established took

place in a controlled environment and systematically implemented in the child with little to no
modifications. Yet again, no dietary consumption information was recorded which allows for the

question to arise that if completed would this create more discipline amongst the child. Another

study referenced took place in a controlled environment and showed results of physical activity in

correlation to those categorized as obese. Among the results, one particular decrease was prevalent

among the participants; at age six to eleven physical activity occurring for an hour or more was

prevalent among forty percent of the participants, at the age of twelve to fifteen that percentage

dropped below ten percent [7]. I think an assumption can be made in regard to childhood activity; as

our youth increase in age activity levels drop. The deeper question to be discovered includes what is

causing this to take place and what intervention strategies can help. Earlier in my review I found that

physical activity components that were apart of interventions yielded more success, mostly due to

the positively influenced encouragement they received in conjunction. Doing so for an extended

period of time and not limiting this component to a short time proved sustained success is dependent

on how consistent intervention was in relation to the growth stages that take place in a child.

School Nutrition Guidelines

Education or lack-there-of in regard to food groups and what normal portions are is another

major contributor. How many children are knowledgeable on what recommended daily intakes are

and how to correlate that to dietary selection [7]. The reality is that for the most part they dont, in a

growing child adult dependency for many things (not just the diet) is very prevalent. So this can be

considered for my next point, how much education early on in a childs life focuses on educating

them about specific macro/micro nutrients and what their specific intakes should be. To consider

what Ive already discovered it is important to remember that early on in a childs life their

constantly growing and high levels of fat are needed for sustainable growth. However, how much is

too much. What education is naturally present in schools aligned with strict curriculum focused on

highlighting boundaries of intake. The WHO Collaborating Center to Promote Health through

Schools and Communities completed an assessment that successfully linked academic success with

strategies enhancing student achievement through dietary education. The results were somewhat
staggering and are outlined below in five principles that are linked to success; healthy school

communities have a school culture that understands health and uses it as an effective strategy for

student achievement, healthy school communities have an active school culture that values physical

activity, school communities that value healthy nutrition education, school communities that value

democracy, participation, inclusion, and equity, school communities have a shared responsibility for

children and youth, school communities support professional development and provide a healthy

work setting, and finally school communities have a culture that values evidence based decision

making and evaluation [8]. These components are all proven for a track record of success and

implementation is absolutely crucial in providing resources for these children to sustain healthy

growth patterns.

In conclusion the fact based trends are very noticeable in looking at the bigger picture which in

this case is lowering the obesity population amongst our youth. Much of the above research

mentioned includes locations from all over the world and in most cases includes a very diverse range

of individuals. Participation included with discipline to carry out effective interventions has shown

that in order to be successful all members associated with the childhood of an adolescent are needed

to be used. This includes everything listed from the beginning of the paper as main ideas and much

more. One thing that was noticed throughout reading all of the interventions utilized, dietary record

did not play a major role at all however it was used briefly in certain situations. Recorded intakes

proved to be too time consuming for parents and guardians to partake in and when it was prevalent

high errors were associated. Health education proved to be most effective when interactive methods

were used in a skills-based approach that involved the school, parents, family members, and anyone

else associated with the child. There is still many areas that need to be researched but statistics dont

lie. Implementing many of the listed interventions require much discipline to carry out and in certain

instances recording dietary intake could hypothetically be useful. Studies revealed that interventions

taking place utilizing this component when utilized correctly allowed for much success to follow.

Creating the discipline to incorporate moderation proved to be difficult in the constant-changing

mind of an adolescent considering the psychosocial factors that affect a multitude of things. So many

stimulus prevent consistency from being attained in the life of a child evidence leans towards

likelihood of success low without the assistance of a parent or guardian.

Much of the above information can be considered in applications to practice associated with our

adolescent obese population. We have learned based on statistics that proactive and preventative

interventions yield the most long term success. Incorporating high emphasis on added sugar and fat

general recommendations into education and intervention appears to be very important to a

successful decrease in obesity prevalence. Also, after viewing many specific interventions it is

incredibly important to remember that every factor associated with each child is different than the

rest. Incorporating interventions designed primarily for an individual have the potential to be more

effective, mostly due to the increased likelihood that knowledge correlates with consistent output.

More importantly, interventions for a child that drinks excess added sugar drinks and eats high fat

foods needs to incorporate intervention that slowly over time separate from that lifestyle. Quick

intervention techniques showed little long term success due to the momentary focus that didnt show

emphasis on the long term discipline of the child. If you think about it, anyone can implement a

healthy intervention but what are the odds that it will be sustained long enough to prevent obesity

from occurring or continuing. Designing intervention programs and implementing them for

individuals appeared to be so broad that success rates reflected it. Numbers proved that broad areas

of interventions yielded lower success and the amount of individuals now classified as obese is still

very high. The dietician can be utilized extensively in the school system to redirect individual focus

and allow for each child struggling with this matter to have a fighting chance and be able to receive

at least some form of one-on-one coaching. After much research into what works I have not read one

fact pertaining to this occurring and considering application, it could be a very good start!
BMC Public Health, 2013, Vol. 13 Issue 1, p1-26, 26p, 2 Diagrams, 1 Chart, 1 Graph
Diagram; found on pN.PAG

Nutrition Reviews, 2015 Supplement, Vol. 73, p175-206, 32p, 8 Charts, 1 Graph
Chart; found on p178 part. 2
 Nutrition Reviews, 2015 Supplement, Vol. 73, p175-206, 32p, 8 Charts, 1 Graph
Chart; found on p179

Nutrition Reviews, 2015 Supplement, Vol. 73, p175-206, 32p, 8 Charts, 1 Graph
Chart; found on p180
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9. BMC Public Health, 2013, Vol. 13 Issue 1, p1-26, 26p, 2 Diagrams, 1 Chart, 1 Graph
Diagram; found on pN.PAG

10. Nutrition Reviews, 2015 Supplement, Vol. 73, p175-206, 32p, 8 Charts, 1 Graph
Chart; found on p178 part. 2

11. Nutrition Reviews, 2015 Supplement, Vol. 73, p175-206, 32p, 8 Charts, 1 Graph
Chart; found on p179

12. Nutrition Reviews, 2015 Supplement, Vol. 73, p175-206, 32p, 8 Charts, 1 Graph
Chart; found on p180