Three-Year Improvements in Weight Status and Weight-Related Behaviors in Middle School Students: The Healthy Choices StudyReport as inadecuate

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Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting.


Evaluate Healthy Choices HC, a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight-obesity.


We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools’ socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight-obesity associated with program components.


Consecutive sample of 45 of 51 middle schools participating in the HC program with complete baseline and follow-up survey data including a subsample of 35 schools with measured anthropomentry for 5,665 7th grade students.


Schools developed a multi-disciplinary team and implemented an obesity prevention curriculum, before and after school activities, environmental and policy changes and health promotions targeting a 5-2-1 theme: eat ≥ 5 servings-day of fruits and vegetables FV, watch ≤ 2 hours of television TV and participate in ≥ 1 hours-day of physical activity PA on most days

Main Outcome Measures

1 School-level percent of students achieving targeted behaviors and percent overweight-obese; and 2 individual odds of overweight-obesity.


The percent achieving behavioral goals over three years increased significantly for FV: 16.4 to 19.4 p = 0.001, TV: 53.4 to 58.2 p = 0.003 and PA: 37.1 to 39.9 p = 0.02, adjusting for school size, baseline mean age and percent female, non-Hispanic White, and eligible for free and reduced price lunch. In 35 schools with anthropometry, the percent of overweight-obese 7th grade students decreased from 42.1 to 38.4 p = 0.016. Having a team that met the HC definition was associated with lower odds of overweight-obesity OR = 0.83, CI: 0.71–0.98.

Conclusions and Relevance

The HC multi-component intervention demonstrated three-year improvements in weight-related behaviors and weight status across diverse middle schools. Team building appears important to the program’s effectiveness.

Author: Karen E. Peterson, Jennifer L. Spadano-Gasbarro, Mary L. Greaney, S. Bryn Austin, Solomon Mezgebu, Anne T. Hunt, Emily A. Blood,



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