Shape Up Somerville two-year results: a community-based environmental change intervention sustains weight reduction in children.

OBJECTIVE: The objective of this study was to test the hypothesis that community-based environmental change intervention prevents undesirable weight gain in children. METHOD: The method used in this study was a two-year, non-randomized, controlled trial (2003-2005) using community-based participatory methodology in three diverse cities in Massachusetts: one intervention and two socio-demographically-matched control communities (pooled for analysis). Children (n=1028), with a mean age=7.61+1.04years participated. Interventions were made to improve energy balance by increasing physical activity options and availability of healthful foods (Year 1). To firmly secure sustainability, the study team supported policies and shifted intervention work to community members (Year 2). RESULTS: Change in body mass index z-score (BMIz) was assessed by multiple regression, accounting for clustering within communities and adjusting for baseline covariates. Sex-specific overweight/obesity prevalence, incidence and remission were assessed. Over the two-year period, BMIz of children in the intervention community decreased by -0.06 [p=0.005, 95% confidence interval: -0.08 to -0.04] compared to controls. Prevalence of overweight/obesity decreased in males (OR=0.61, p=0.01) and females (OR=0.78, p=0.01) and remission increased in males (OR 3.18, p=0.03) and females (OR 1.93, p=0.03) in intervention compared to controls. CONCLUSION: Results demonstrate promise for preventing childhood obesity using a sustainable multi-level community-based model and reinforce the need for wide-reaching environmental and policy interventions.

Retooling food service for early elementary school students in Somerville, Massachusetts: the Shape Up Somerville experience.

BACKGROUND: Changes in the school food environment are a logical target to prevent childhood overweight. We describe the food service component of a 2-year research intervention to prevent excess weight gain in children. CONTEXT: The goals of the food service component were to improve the presentation and nutrient quality of school meals and to incorporate more fruits and vegetables into students' diets. The project engaged food service staff, students, parents, teachers, and school leaders to improve school nutrition. METHODS: Modifications addressed needs and barriers identified though dialogue with the food service director, focus groups, key informant interviews, and surveys of school employees, students, and parents and guardians. Attitudes and behavior changes were measured through surveys, direct observation, and sales data. CONSEQUENCES: More fruits, vegetables, whole grains, and low-fat dairy products were available during the intervention years; menus and à la carte choices were brought into closer compliance with recommended guidelines for children; attitudes of students, parents and guardians, school faculty, and food service staff improved; and policies related to food service were adopted. INTERPRETATION: Strategic modification to improve nutrition and increase acceptability of the food served in schools is feasible and sustainable. These results demonstrate that changes to food service can lead to improved nutrient profiles and more favorable attitudes toward food served at school meals. Such changes can help prevent childhood obesity.

School-based behavioral assessment tools are reliable and valid for measurement of fruit and vegetable intake, physical activity, and television viewing in young children.

Interventions aiming to modify the dietary and physical activity behaviors of young children require precise and accurate measurement tools. As part of a larger community-based project, three school-based questionnaires were developed to assess (a) fruit and vegetable intake, (b) physical activity and television (TV) viewing, and (c) perceived parental support for diet and physical activity. Test-retest reliability was performed on all questionnaires and validity was measured for fruit and vegetable intake, physical activity, and TV viewing. Eighty-four school children (8.3+/-1.1 years) were studied. Test-retest reliability was performed by administering questionnaires twice, 1 to 2 hours apart. Validity of the fruit and vegetable questionnaire was measured by direct observation, while the physical activity and TV questionnaire was validated by a parent phone interview. All three questionnaires yielded excellent test-retest reliability (P<0.001). The majority of fruit and vegetable questions and the questions regarding specific physical activities and TV viewing were valid. Low validity scores were found for questions on watching TV during breakfast or dinner. These questionnaires are reliable and valid tools to assess fruit and vegetable intake, physical activity, and TV viewing behaviors in early elementary school-aged children. Methods for assessment of children's TV viewing during meals should be further investigated because of parent-child discrepancies.

A community intervention reduces BMI z-score in children: Shape Up Somerville first year results.

OBJECTIVE: The objective was to test the hypothesis that a community-based environmental change intervention could prevent weight gain in young children (7.6 +/- 1.0 years). RESEARCH METHODS AND PROCEDURES: A non-randomized controlled trial was conducted in three culturally diverse urban cities in Massachusetts. Somerville was the intervention community; two socio-demographically-matched cities were control communities. Children (n = 1178) in grades 1 to 3 attending public elementary schools participated in an intervention designed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before-, during-, after-school, home, and community environments. Many groups and individuals within the community (including children, parents, teachers, school food service providers, city departments, policy makers, healthcare providers, before- and after-school programs, restaurants, and the media) were engaged in the intervention. The main outcome measure was change in BMI z-score. RESULTS: At baseline, 44% (n = 385), 36% (n = 561), and 43% (n = 232) of children were above the 85th percentile for BMI z-score in the intervention and the two control communities, respectively. In the intervention community, BMI z-score decreased by -0.1005 (p = 0.001, 95% confidence interval, -0.1151 to -0.0859) compared with children in the control communities after controlling for baseline covariates. DISCUSSION: A community-based environmental change intervention decreased BMI z-score in children at high risk for obesity. These results are significant given the obesigenic environmental backdrop against which the intervention occurred. This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates.