title: A policy-based school intervention to prevent overweight and obesity.
abstract: BACKGROUND
  The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic settings. Schools are ideal settings for population-based interventions to address obesity.
  
  
  OBJECTIVE
  The purpose of this work was to examine the effects of a multicomponent, School Nutrition Policy Initiative on the prevention of overweight (85.0th to 94.9th percentile) and obesity (> 95.0th percentile) among children in grades 4 through 6 over a 2-year period.
  
  
  METHODS
  Participants were 1349 students in grades 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with > or = 50% of students eligible for free or reduced-price meals. Schools were matched on school size and type of food service and randomly assigned to intervention or control. Students were assessed at baseline and again after 2 years. The School Nutrition Policy Initiative included the following components: school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach.
  
  
  RESULTS
  The incidences of overweight and obesity after 2 years were primary outcomes. The prevalence and remission of overweight and obesity, BMI z score, total energy and fat intake, fruit and vegetable consumption, body dissatisfaction, and hours of activity and inactivity were secondary outcomes. The intervention resulted in a 50% reduction in the incidence of overweight. Significantly fewer children in the intervention schools (7.5%) than in the control schools (14.9%) became overweight after 2 years. The prevalence of overweight was lower in the intervention schools. No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years.
  
  
  CONCLUSIONS
  A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grades 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals.
authors.affiliation: Center for Obesity Research and Education, Temple University, 3223 N Broad St, Suite 175, Philadelphia, PA 19140, USA. gfoster@temple.edu
authors.forename: Gary D
authors.initials: GD
authors.lastname: Foster
authors.forename: Sandy
authors.initials: S
authors.lastname: Sherman
authors.forename: Kelley E
authors.initials: KE
authors.lastname: Borradaile
authors.forename: Karen M
authors.initials: KM
authors.lastname: Grundy
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Vander Veur
authors.forename: Joan
authors.initials: J
authors.lastname: Nachmani
authors.forename: Allison
authors.initials: A
authors.lastname: Karpyn
authors.forename: Shiriki
authors.initials: S
authors.lastname: Kumanyika
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D002664:Child Nutritional Physiological Phenomena; D016001:Confidence Intervals; D005260:Female; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D015994:Incidence; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control*; D011050:Policy Making; D011336:Probability; D015397:Program Evaluation; D018570:Risk Assessment; D012572:School Health Services / Q000458:organization & administration*; D012680:Sensitivity and Specificity; D017678:Sex Distribution