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Mixed results on school-based intervention to decrease obesity in adolescents
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ORLANDO — A multicomponent, school-based intervention program that promoted healthy behaviors did not decrease rates of obesity or overweight in adolescents at high risk for type 2 diabetes, but was associated with improvements in insulin levels, decreased BMI z scores and reduced waist circumference, according to results of the HEALTHY Study.
The goal of the National Institutes of Health-sponsored HEALTHY Study was to determine whether changes in school food services, more intense periods of physical education and classroom activities to promote behavior change would lower risk factors for type 2 diabetes.
Researchers randomly assigned 4,603 students from 42 schools to a multicomponent school-based intervention program (n=21) or no intervention at a comparison school (n= 21). Students were followed from sixth grade to eighth grade. The schools had a high enrollment of minority children (54% Hispanic; 18% black) and youth from low-income families.
Obesity or overweight was no different for students at the two schools. Students assigned to the intervention recorded a 4% reduction in weight vs. a 4.5% reduction at comparison schools. The combined reduction in obesity and overweight was 16%.
“Surprisingly, this means that control schools in which no intervention happened actually reduced the rates for overweight and obesity. This would suggest to us that the rates for overweight and obesity even among high-risk students seem to be decreasing,” Gary D. Foster, PhD, of Temple University, said during a press conference.
Moreover, the intervention program lowered insulin levels, decreased BMI z scores and reduced the percentage of students with a waist circumference above the 90th percentile compared with the comparison school (P=.04).
“What is alarming is what was formally considered a disease in adults, is now found in children. When experts began designing the HEALTHY study, the pilot studies that preceded it were reporting that obesity rates in youth had been climbing steadily for two decades,” Griffin P. Rodgers, MD, director of the National Institute of Diabetes and Digestive and Kidney Diseases, said at the press conference.
“In short, we needed to find ways to contain the rising rate of type 2 diabetes in children and schools were the logical place to start,” Rodgers said.
Future analyses will examine why overweight and obesity declined in both groups of schools by a nearly identical rate. The researchers postulated that the study may have encouraged greater awareness of healthy behaviors; students were given results of health screens and notified of abnormal weight or blood tests; and were encouraged to follow-up with a health care provider.
The results of the HEALTHY Study were presented here and simultaneously published in The New England Journal of Medicine. – by Jennifer Southall
In the 1990s we began seeing a rise in the rate of type 2 diabetes among adolescents. The relevance of the HEALTHY Study to this group is that the average age of diagnosis of type 2 diabetes is about age 13 for girls and 14 for boys. This study was designed to intervene during a time when the risk for type 2 diabetes is rising steeply in these children. Another thing we need to understand about type 2 diabetes is that ultimately the physiology is a combination of insulin resistance and an inadequate ability of the body to make sufficient insulin to overcome the resistance to maintain blood glucose.
– Phil Zeitler, MD, PhD
Associate Professor
of Pediatrics, Barbara Davis Center for Childhood Diabetes
For more information:
- HEALTHY Study – Middle school-based intervention to reduce diabetes risk. Presented at:American Diabetes Association 70th Scientific Sessions; June 25-29, 2010; Orlando.
- The HEALTHY Study Group. N Engl J Med. 2010;doi:10.1056/NEJMoa1001933.