1 University of North Dakota, Grand Forks, ND, USA.
Health Educ Behav. 2018 Apr;45(2):277-285. doi: 10.1177/1090198117714825. Epub 2017 Jul 10.
Childhood obesity is a significant but largely modifiable health risk, disproportionately affecting socioeconomically disadvantaged, racial/ethnic minority, and rural children. Elementary school-aged children typically experience the greatest increases in excess weight gain and therefore are important targets for reducing adolescent and adult obesity while improving children's health. Our study evaluated outcomes of a 3-year elementary school-based program for reducing obesity in American Indian and White students attending eight rural schools in the U.S. upper Midwest.
Researchers measured body mass indexes (BMI) and other health indicators and behaviors of 308 beginning third-grade students and then again at the end of students' third, fourth, and fifth grades. The primary focus of this study is a mixed multilevel longitudinal model testing changes in age- and gender-adjusted BMI z scores ( zBMI).
There was a significant decrease in zBMI across the 3-year study period. Ethnicity analyses showed that White students had overall decreases in zBMI whereas American Indian students' zBMIs remained stable across the program. Comparisons with children from an age- and cohort-matched national sample provided support for the effectiveness of the school program in reducing BMI and obesity during the study period.
An elementary school-based health program that addresses a range of students' obesity-related health behaviors, the school health environment, and that involves educators and parents is an effective intervention for reducing or stabilizing BMI in rural White and American Indian students. School health programs for students living in rural communities may be especially effective due to greater school and community cohesiveness, and valuing of the school's primary role in improving community health.
儿童肥胖是一个重大但在很大程度上可以改变的健康风险，它不成比例地影响着社会经济地位处于不利地位、属于少数族裔的儿童和农村儿童。小学年龄段的儿童通常经历体重过度增加的最大增长，因此是减少青少年和成年肥胖症同时改善儿童健康的重要目标。我们的研究评估了一项为期 3 年的基于小学的计划在美国中西部北部 8 所农村学校中减少美国印第安人和白人学生肥胖的结果。
研究人员测量了 308 名开始上三年级的学生的体重指数（BMI）和其他健康指标和行为，然后在学生三年级、四年级和五年级结束时再次进行测量。本研究的主要重点是一个混合多层次纵向模型，用于测试年龄和性别调整后的 BMI z 分数（zBMI）的变化。
在 3 年的研究期间，zBMI 显著下降。种族分析表明，白人学生的 zBMI 总体下降，而美国印第安学生的 zBMI 在整个项目中保持稳定。与来自年龄和队列匹配的全国样本的儿童进行比较，为该学校项目在研究期间减少 BMI 和肥胖提供了支持。
一项基于小学的健康计划，针对一系列学生与肥胖相关的健康行为、学校健康环境，并涉及教育工作者和家长，是减少或稳定农村白人和美国印第安学生 BMI 的有效干预措施。对于生活在农村社区的学生的学校健康计划可能特别有效，因为学校和社区的凝聚力更强，并且重视学校在改善社区健康方面的主要作用。
