title: A holistic school-based intervention for improving health-related knowledge, body composition, and fitness in elementary school students: an evaluation of the HealthMPowers program.
abstract: BACKGROUND
  Over the past 30 years, obesity in the United States has increased twofold in children and threefold in adolescents. In Georgia, nearly 17% of children aged 10 - 17 are obese. In response to the high prevalence of child obesity in Georgia and the potential deleterious consequences that this can have, HealthMPowers was founded in 1999 with the goal of preventing childhood obesity by improving health-enhancing behaviors in elementary schools, utilizing a holistic three-year program. This study measures the effectiveness of the HealthMPowers program in improving the school environment, student knowledge, behavior, cardiovascular fitness levels, and Body Mass Index (BMI).
  
  
  METHODS
  The present analysis utilizes data from 40 schools that worked with HealthMPowers over the course of the 2012 - 2013 school year (including schools at each of the three years of the intervention period) and provided information on demographics, student knowledge and behaviors, BMI, performance on the PACER test of aerobic capacity, and school practices and policies (measured via school self-assessment with the HealthMPowers-developed instrument "Continuous Improvement Tracking Tool" or CITT), measured at the beginning and end of each school year. Paired two-sample T tests were used to compare continuous variables (e.g., student knowledge scores, BMI-for-age Z scores), while chi-squared tests were used to assess categorical variables (e.g., trichotomized PACER performance).
  
  
  RESULTS
  Students across all grades and cohorts demonstrated improvements in knowledge and self-reported behaviors, with particularly significant improvements for third-graders in schools in the second year of the HealthMPowers program (p < 0.0001). Similarly, decreases were observed in BMI-for-Age Z scores for this cohort (and others) across grades and gender, with the most significant decreases for students overweight or obese at baseline (p < 0.0005). Students also showed significant increases in performance on the PACER test across grades and cohorts (p < 0.0001). Lastly, schools tended to improve their practices over time, as measured via the CITT instrument.
  
  
  CONCLUSIONS
  The present report demonstrates the effectiveness of the HealthMPowers program in producing positive change in school policies and practices, student knowledge and behaviors, and student fitness and BMI, supporting the use of holistic interventions to address childhood obesity.
authors: Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA. rmburke@emory.edu.
authors: Rachel M
authors: RM
authors: Burke
authors: Adria
authors: A
authors: Meyer
authors: Christi
authors: C
authors: Kay
authors: Diane
authors: D
authors: Allensworth
authors: Julie A
authors: JA
authors: Gazmararian
mesh_terms: D000293:Adolescent; D001823:Body Composition; D015992:Body Mass Index; D002648:Child; D005260:Female; D005845:Georgia; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009043:Motor Activity; D050177:Overweight / Q000517:prevention & control*; D063766:Pediatric Obesity / Q000517:prevention & control*; D012574:Schools; D013334:Students; D011795:Surveys and Questionnaires