Youth Obesity Prevention
Our evidence-based Health in Motion energy balance program is targeted for adolescents and focuses on three areas critical for obesity prevention:
- Increasing physical activity
- Eating more fruits and vegetables
- Reducing TV time
This internet delivered program includes voice-overs read by adolescents, ten full-motion videos of adolescents encouraging and motivating each other to exercise, eat healthy, and limit TV time, and interactive Flash animations to keep youths’ interest.
Background
Development and testing of this program was supported by a grant from the National Heart, Lung, and Blood Institute. A randomized clinical effectiveness trial with 1800 students was conducted in schools in Tennessee, New York, Massachusetts, and Rhode Island.
Effectiveness
- Moved treatment group participants (at greater proportions than seen in the control group) to national guideline criteria for physical activity (28.5%), for fruit and vegetable consumption (35.5%), and for TV viewing (45.5%).
At the end of the intervention, the treatment group increased their physical activity of at least 60 minutes by 1 additional day (while the control group increased that much activity by 1/3 of a day), increased their fruit and vegetable consumption by 1.5 servings per day (while the control group increased by ½ of a serving), and reduced their daily television viewing by 1 hour (while the control group reduced by ½ an hour). At the 12 month follow-up time point, the treatment group continued to outperform the control group on all three of these measures.
The intervention was successful at moving treatment group participants to national guideline criteria for physical activity (28.5%), for fruit and vegetable consumption (35.5%), and for TV viewing (45.5%). These effects were relatively stable for the treatment group out to the 12 month follow-up time point.
A noteworthy success of Health in Motion is its ability to treat multiple risks simultaneously. Among treatment group participants, those students who progressed to criteria for one behavior were 4.2 to 2.1 times more likely to make the similar progress on another behavior. This finding was not found among control group participants.
The program is presently in a randomized clinical trial in 20 middle schools.
A demonstration of the program can be viewed at: www.prochange.com\obesitydemo.
Presentations
Over 15 presentations on this work have been made at: the Cooper Institute; the Society of Behavioral Medicine; the American Public Health Association; the Alliance for Health, Physical Education, Recreation and Dance; and the National Association of School Psychologists. Two young investigator awards were received for abstracts presented at the Cooper Institute in 2004 and 2005. In 2009 two presentations made at the Society of Behavioral Medicine received Meritorious Student Awards and one received a Citation Award from the Multiple Health Behavior Special Interest Group.
Sherman, K.J., Mauriello, L.M., Paiva, A.L., Driskell, M.M. & Castle, P.H. (2009). Co-variation of multiple behavior change: Synergistic effects of an obesity prevention program. Paper presented at the annual conference of the Society of Behavioral Medicine, Montreal, Canada.
Mauriello, L.M., Sherman, K.J., Paiva, A.L., Ciavatta (Driskell), M.M., Castle, P.H., Johnson, J.J. & Prochaska, J.M. (2009). 12-month outcomes of a multimedia obesity prevention program for adolescents. Paper presented at the annual conference of the Society of Behavioral Medicine, Montreal, Canada.
Publications
Driskell, M.M., Dyment, S.J., Mauriello, L.M., Castle, P.H., & Sherman, K.J. (2008). Relationships among multiple behaviors for childhood and adolescent obesity prevention. Preventive Medicine, 46, 209-215. abstract
Abstract:
Background: Curbing the epidemic of childhood and adolescent obesity requires impacting multiple behaviors. This article examines the interrelationships of physical activity, fruit and vegetable consumption, and limiting television time among elementary, middle, and high school students.
Methods: Nationwide samples of students in grades 4 through 12 (n=4,091) completed self-administered questionnaires assessing Transtheoretical Model (TTM) constructs and behavioral indicators for physical activity, fruit and vegetable consumption, and limiting television time. Analyses were conducted to compare the prevalence of students at-risk for the target behaviors across the age groups and to examine the interrelationships of the target behavior risks.
Results: Across the three age groups, physical activity and fruit and vegetable consumption declined, while limiting TV time increased. In addition, high school students had the greater number of behavioral risks. Across all three samples, being at-risk for one behavior almost always significantly increased the odds of being at-risk for another behavior.
Conclusion: The findings of this study provide further evidence for the need for early promotion of healthy lifestyle behaviors. The relationships among the target behaviors in three samples strongly support a multiple behavior approach for obesity prevention. TTM-based tailored interventions are now being used to address multiple behaviors without overwhelming students.
Mauriello, L.M., Sherman, K.J., Driskell, M.M., & Prochaska, J.M. (2007). Using interactive behavior change technology to intervene on physical activity and nutrition with adolescents. Adolescent Medicine: State of the Art Reviews, 18, 383-399. abstract
Abstract: This article describes the development and pilot testing of a computer-based, multiple-behavior obesity prevention program for adolescents. Using the Transtheoretical Model as a framework, this intervention offers individualized feedback based on readiness to engage in physical activity, to consume fruits and vegetables, and to limit television viewing. Focus groups and interviews with students, teachers, school administrators, and experts guided the development. Forty-five students participated in a baseline intervention session and completed a 16-item acceptability measure. Ratings were positive, with item means ranging from 3.60-4.75 on a 5-point scale. Student responses to open-ended questions aided in the enhancement of the intervention, for which an effectiveness trial begins in September 2006. This formative work demonstrated the acceptability of this school-based intervention approach, which can be promoted and prescribed by school nurses. Further, if found effective, it can be disseminated as an efficient, low-cost, population-based approach designed to address the epidemic of obesity.
Mauriello, L. M., Driskell, M. M., Sherman, K. J., Johnson, S. S., Prochaska, J. M., & Prochaska, J. O. (2006). Acceptability of a school-based intervention for the prevention of adolescent obesity. Journal of School Nursing, 22, 269-277.
Bully
Obesity Prevention at the Elementary School Level
Assessments
Assessments of the Transtheoretical Model constructs (stage of change, pros and cons, self-efficacy, and processes of change) have been developed and validated for elementary school students for physical activity, fruit and vegetable consumption, and limited TV viewing. These assessments are available for purchase.
Family Guide
This short guide offers parents and guardians information on critical behaviors for promoting energy balance and preventing obesity among youth including physical activity, fruit and vegetable consumption, and limited TV viewing. Family members are offered guidance on assessing how ready their child is to meet national guidelines for these behaviors. Tips for encouraging healthy lifestyles at home are offered.
Training
Pro-Change staff is available to conduct half day trainings on incorporating the Transtheoretical Model of Behavior Change into youth wellness programs and curriculum. Background on the model, information on assessing the stage of readiness of the youth to do the target behaviors, and ideas for incorporating stage-matched messages and activities into your program are offered.
