title: Three-Year Improvements in Weight Status and Weight-Related Behaviors in Middle School Students: The Healthy Choices Study.
abstract: BACKGROUND
  Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  1) School-level percent of students achieving targeted behaviors and percent overweight/obese; and 2) individual odds of overweight/obesity.
  
  
  RESULTS
  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
  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.
authors: Department of Nutritional Sciences, School of Public Health and Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, United States of America; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
authors: Karen E
authors: KE
authors: Peterson
authors: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
authors: Jennifer L
authors: JL
authors: Spadano-Gasbarro
authors: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America; Center for Community-Based Research, Dana Farber Cancer Institute, Boston, Massachusetts, United States of America; Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island, United States of America.
authors: Mary L
authors: ML
authors: Greaney
authors: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
authors: S Bryn
authors: SB
authors: Austin
authors: Nutrition Program North East Region, United States Department of Agriculture (USDA), Boston, Massachusetts, United States of America.
authors: Solomon
authors: S
authors: Mezgebu
authors: Hunt Consulting Associates, Logan, Utah, United States of America.
authors: Anne T
authors: AT
authors: Hunt
authors: Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors: Emily A
authors: EA
authors: Blood
authors: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America.
authors: Chrissy
authors: C
authors: Horan
authors: Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors: Henry A
authors: HA
authors: Feldman
authors: Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors: Stavroula K
authors: SK
authors: Osganian
authors: Massachusetts Department of Public Health, Boston, Massachusetts, United States of America.
authors: Maria F
authors: MF
authors: Bettencourt
authors: Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
authors: Tracy K
authors: TK
authors: Richmond
mesh_terms: D000124:Achievement; D000293:Adolescent; D000886:Anthropometry; D001835:Body Weight / Q000502:physiology; D002755:Choice Behavior; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D050177:Overweight / Q000178:diet therapy* / Q000517:prevention & control; D063766:Pediatric Obesity / Q000178:diet therapy* / Q000517:prevention & control; D012572:School Health Services / Q000458:organization & administration; D012574:Schools; D013334:Students; D014675:Vegetables