Worth its weight (loss) in gold: The effects of Utah's Gold-Medal school policy on adolescent obesity by neighborhood SES

Little population-based research has been undertaken of the effectiveness of school policies directed toward childhood obesity, much less on variation of impact across socioeconomic characteristics of neighborhoods. Utah's Gold Medal School Program (GMSP),a state-based wellness program, was legislated for voluntary adoption by elementary schools beginning in 2001. Multilevel analysis of the effect of the GMSP on adolescent obesity was undertaken, including the extent to which such effects were modified by socioeconomic characteristics of neighborhoods where students reside. Data were taken from the Utah Population Database (UPDB), a genealogically-linked resource comprised of administrative data on all residents. Most individual and household characteristics were taken from birth certificate records, whereas height and weight were extracted from linked driver's license records. Residential information was used to geo-code and link block-level characteristics as well as school assignment. The resulting sample for the 1990-92 birth cohorts exposed to the GMSP by 2001 was 30,512. Hierarchical linear modeling was performed on the odds of obesity associated with extent of adoption of the GMSP and with its interaction with neighborhood characteristics, controlling for individual and household characteristics. Higher level adoption of the GMSP significantly reduced the odds of adolescent obesity, particularly for those in the most disadvantaged neighborhoods. This analysis suggests that childhood obesity can be managed through concerted policy efforts at the elementary school level, particularly for those at greatest risk.