title: Healthier School Environment Leads to Decreases in Childhood Obesity: The Kearney Nebraska Story.
abstract: BACKGROUND
  Schools play a role in addressing childhood obesity by implementing healthy eating and physical activity strategies. The primary aim of this case study was to describe prevalence of overweight and obesity among elementary school students in a rural Mid-western community between 2006 and 2012. The secondary aim was to use a novel approach called "population dose" to retrospectively evaluate the impact dose of each strategy implemented and its estimated potential population level impact on changes in overweight and obesity.
  
  
  METHODS
  Weight and height were directly measured annually beginning in January 2006 to assess weight status, using BMI (kg/m(2)), for all kindergarten to fifth-grade students (N ≈ 2400 per year). Multiple evidence-based strategies were implemented in nine schools to increase physical activity and healthy eating behaviors. BMI reporting and revised school meal programs were implemented districtwide. Comprehensive school physical activity programs, school food environment, and supportive/promotional strategies were implemented at individual schools.
  
  
  RESULTS
  The absolute change in prevalence of obesity (BMI ≥95th percentile) decreased from 16.4% to 13.9%, indicating a 15.2% relative change in prevalence of obesity in 6 years. There was an inverse relationship between the number of strategies implemented and prevalence of overweight and obesity over time.
  
  
  CONCLUSIONS
  District and school-level approaches have the potential to impact childhood obesity. Schools can successfully implement strategies to address overweight and obesity, but the extent of implementation between schools may vary. Population dose analysis can be used to estimate impact of clusters of strategies to address overweight/obesity.
authors.affiliation: 1 Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney , Kearney, NE.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Heelan
authors.affiliation: 1 Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney , Kearney, NE.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Bartee
authors.affiliation: 2 Division of Population Health, Centers for Disease Control and Prevention , Atlanta, GA.
authors.forename: Allison
authors.initials: A
authors.lastname: Nihiser
authors.affiliation: 3 Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention , Atlanta, GA.
authors.forename: Bettylou
authors.initials: B
authors.lastname: Sherry
mesh_terms: D015992:Body Mass Index; D002648:Child; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009329:Nebraska / Q000453:epidemiology; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010806:Physical Education and Training / Q000458:organization & administration*; D015995:Prevalence; D012189:Retrospective Studies; D012572:School Health Services / Q000458:organization & administration*; D012574:Schools; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data