标题：Effect of a Two-Year Obesity Prevention Intervention on Percentile Changes in Body Mass Index and Academic Performance in Low-Income Elementary School Children
摘要：Objectives. We assessed the effects of a school-based obesity prevention intervention that included dietary, curricula, and physical activity components on body mass index (BMI) percentiles and academic performance among low-income elementary school children. Methods. The study had a quasi-experimental design (4 intervention schools and 1 control school; 4588 schoolchildren; 48% Hispanic) and was conducted over a 2-year period. Data are presented for the subset of the cohort who qualified for free or reduced-price school lunches (68% Hispanic; n = 1197). Demographic and anthropometric data were collected in the fall and spring of each year, and academic data were collected at the end of each year. Results. Significantly more intervention than control children stayed within normal BMI percentile ranges both years ( P = .02). Although not significantly so, more obese children in the intervention (4.4%) than in the control (2.5%) decreased their BMI percentiles. Overall, intervention schoolchildren had significantly higher math scores both years ( P < .001). Hispanic and White intervention schoolchildren were significantly more likely to have higher math scores ( P < .001). Although not significantly so, intervention schoolchildren had higher reading scores both years. Conclusions. School-based interventions can improve health and academic performance among low-income schoolchildren. The prevalence of obesity remains high among all age and racial groups in the United States, particularly among African Americans, Hispanic and Mexican Americans, and low-income children. 1 , 2 Childhood-onset obesity is related to numerous risk factors for cardiometabolic disease that track from childhood into adulthood, including elevated blood pressure and lipids. 3 – 8 Additionally, studies have documented the mental health consequences of childhood obesity, including low self-esteem and higher rates of anxiety disorders, depression, and other psychopathologies among overweight and obese children. 9 – 12 How childhood overweight affects academic performance, however, is less well understood. Studies show that in addition to socioeconomic status, obesity, poor nutrition, and food insufficiency affect a child's school achievement. 13 – 18 Specifically, students who experience food insufficiency may have lower math scores, social difficulties, and psychological difficulties. 15 , 16 Children described as normal-weight or overweight (versus obese) who are at nutritional risk have lower math scores, poorer attendance, and more behavior problems. 13 , 14 Moreover, young children who become overweight between kindergarten and the end of third grade experience reductions in test scores. 17 , 18 Additionally, severely obese children have been shown to have lower IQs, poorer school performance, and lower test scores than their less-overweight classmates, even after control for behavioral and socioeconomic variables. 19 – 21 Schools play a crucial role in improving the health, and in turn the academic performance, of students. Children generally attend school 5 days per week throughout most of the year, and schools in the United States are located in communities of every socioeconomic and racial/ethnic group. The school environment provides many opportunities to teach children about important health and nutrition practices. The influence of schools on the health of children is strong, especially in low-income communities, where children often receive a significant proportion of their daily nutrition requirements (as much as 51% of daily energy intake) 22 via the US Department of Agriculture (USDA) National School Lunch Program (NSLP) and School Breakfast Program. Healthier Options for Public Schoolchildren (HOPS) was an elementary school–based obesity prevention intervention targeting children aged 6 to 13 years that included nutrition and physical activity components. The goal was to improve overall health status and academic achievement by using replicable strategies. We hypothesized that the intervention would improve academic performance and help to maintain a healthy weight in the intervention children versus a control group.
