title: A socio-ecological approach promoting physical activity and limiting sedentary behavior in adolescence showed weight benefits maintained 2.5 years after intervention cessation.
abstract: BACKGROUND
  Obesity in youth remains a major public health issue. Yet no effective long-term preventive strategy exists. We previously showed that a school-based socio-ecological approach targeting behavior and social/environmental influences on physical activity (PA) prevented 4-year excessive weight gain in 12-year olds. In this study, we investigated if this efficacy persists 30 months after intervention cessation.
  
  
  RESULTS
  The program targeted students, family, school and the living environment to promote/support PA and prevent sedentary behavior (SB). A total of 732 students from eight randomized middle schools completed the 4-year trial. At the 30-month post-trial follow-up, body mass index (BMI), fat mass index (FMI), leisure PA (LPA), home/school/workplace active commuting, TV/video time (TVT), and attitudes toward PA were measured in 531 adolescents. The beneficial effects of the intervention on the excess BMI increase (+0.01 vs +0.34 kg m(-2) in the intervention and control groups, respectively) and on the overweight incidence in initially non-overweight students (4.3% vs 8.6%; odds ratio=0.48 (95% confidence interval: 0.23-1.01)) were maintained at the post-trial follow-up. LPA was not maintained at the level achieved during the trial. However, we still observed a prevention of the age-related decrease of the adolescents' percentage reporting regular LPA (-14.4% vs -26.5%) and a higher intention to exercise in the intervention group. The intervention promoted lower TVT (-14.0 vs +13.6 min per day) and higher active commuting changes (+11.7% vs -4.8%). Trends in higher BMI reduction in students with high initial TVT and in the least wealthy group were noted. TVT changes throughout the follow-up predicted excess BMI and FMI changes.
  
  
  CONCLUSIONS
  Long-term multilevel approach targeting PA and SB prevents excessive weight gain up to 30 months after intervention cessation. The efficacy may be higher in the most sedentary and least wealthy adolescents. Healthy PA-related behavior inducing long-lasting weight effects can be promoted in youth providing that an ecological approach is introduced in the prevention strategy.
authors: 1] CARMEN, INSERM U1060/University of Lyon 1/INRA U1235 Lyon, Lyon, France [2] CRNH Rhône-Alpes and Center for European Nutrition, Safety and Health/University of Lyon 1/Hospices Civils de Lyon, Lyon, France [3] EA 1801, Epidemiology of Cardiovascular Diseases and Cancers, University of Strasbourg, Strasbourg, France.
authors: C
authors: C
authors: Simon
authors: CARMEN, INSERM U1060/University of Lyon 1/INRA U1235 Lyon, Lyon, France.
authors: N
authors: N
authors: Kellou
authors: CARMEN, INSERM U1060/University of Lyon 1/INRA U1235 Lyon, Lyon, France.
authors: J
authors: J
authors: Dugas
authors: Department of Nutrition and Health, College of Food and Agriculture, UAE University, Al Ain, United Arab Emirates.
authors: C
authors: C
authors: Platat
authors: 1] CRNH Rhône-Alpes and Center for European Nutrition, Safety and Health/University of Lyon 1/Hospices Civils de Lyon, Lyon, France [2] EA 1801, Epidemiology of Cardiovascular Diseases and Cancers, University of Strasbourg, Strasbourg, France.
authors: N
authors: N
authors: Copin
authors: Department of Students' Health Promotion, School Academy of Bas-Rhin, Strasbourg, France.
authors: B
authors: B
authors: Schweitzer
authors: EA 3424, University of Strasbourg, Strasbourg, France.
authors: F
authors: F
authors: Hausser
authors: Center for Human Nutrition, Anschutz Medical Campus Health and Wellness Center, University of Colorado, Aurora, CO, USA.
authors: A
authors: A
authors: Bergouignan
authors: CARMEN, INSERM U1060/University of Lyon 1/INRA U1235 Lyon, Lyon, France.
authors: E
authors: E
authors: Lefai
authors: Department of Ecology, Physiology and Ethology, Hubert Curien Pluridisciplinary Institut, CNRS UMR 7178/University of Strasbourg, Strasbourg, France.
authors: S
authors: S
authors: Blanc
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D016000:Cluster Analysis; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D007899:Leisure Activities; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D011634:Public Health; D012572:School Health Services / Q000458:organization & administration; D012574:Schools; D057185:Sedentary Behavior; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015430:Weight Gain