Gortmaker S L, Peterson K, Wiecha J, Sobol A M, Dixit S, Fox M K, Laird N
Department of Health and Social Behavior, Harvard School of Public Health, Boston, Mass 02115, USA.
Arch Pediatr Adolesc Med. 1999 Apr;153(4):409-18. doi: 10.1001/archpedi.153.4.409.
To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grades 6 to 8.
Randomized, controlled field trial with 5 intervention and 5 control schools. Outcomes were assessed using preintervention (fall 1995) and follow-up measures (spring 1997), including prevalence, incidence, and remission of obesity.
A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities.
Students participated in a school-based interdisciplinary intervention over 2 school years. Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education. Sessions focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity.
Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles. Because schools were randomized, rather than students, the generalized estimating equation method was used to adjust for individual-level covariates under cluster randomization.
The prevalence of obesity among girls in intervention schools was reduced compared with controls, controlling for baseline obesity (odds ratio, 0.47; 95% confidence interval, 0.24-0.93; P = .03), with no differences found among boys. There was greater remission of obesity among intervention girls vs. control girls (odds ratio, 2.16; 95% confidence interval, 1.07-4.35; P = .04). The intervention reduced television hours among both girls and boys, and increased fruit and vegetable consumption and resulted in a smaller increment in total energy intake among girls. Reductions in television viewing predicted obesity change and mediated the intervention effect. Among girls, each hour of reduction in television viewing predicted reduced obesity prevalence (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; P = .02).
Planet Health decreased obesity among female students, indicating a promising school-based approach to reducing obesity among youth.
评估一项名为“健康星球”的校内健康行为干预措施对6至8年级男女生肥胖问题的影响。
随机对照现场试验，涉及5所干预学校和5所对照学校。使用干预前（1995年秋季）和随访测量（1997年春季）来评估结果，包括肥胖的患病率、发病率和缓解率。
来自马萨诸塞州4个社区公立学校的1295名6年级和7年级不同种族的学生。
学生在两个学年内参与一项校内跨学科干预。“健康星球”课程被纳入现有课程，由4门主要学科的任课教师和体育教师授课。课程重点在于减少看电视时间、减少高脂肪食物的摄入、增加水果和蔬菜的摄入量以及增加适度和剧烈的体育活动。
肥胖被定义为基于体重指数和三头肌皮褶厚度值的综合指标，该值大于或等于特定年龄和性别的第85百分位数。由于是对学校进行随机分组，而非学生，因此采用广义估计方程法在整群随机化情况下对个体水平的协变量进行调整。
在控制基线肥胖情况后，干预学校女生的肥胖患病率与对照组相比有所降低（优势比，0.47；95%置信区间，0.24 - 0.93；P = 0.03），男生中未发现差异。干预组女生的肥胖缓解情况优于对照组女生（优势比，2.16；95%置信区间，1.07 - 4.35；P = 0.04）。该干预措施减少了男女生看电视的时长，增加了水果和蔬菜的摄入量，并使女生的总能量摄入增加幅度更小。看电视时间的减少预示着肥胖的变化，并介导了干预效果。在女生中，每减少一小时看电视时间预示着肥胖患病率降低（优势比，0.85；95%置信区间，0.75 - 0.97；P = 0.02）。
“健康星球”干预措施降低了女学生的肥胖率，表明这是一种有前景的校内减少青少年肥胖的方法。
