Implementation Results of a School-Based Obesity Prevention Strategy

Background. School-based interventions are a potential weapon against the continuing increase of overweight and obesity among children in the United States. Purpose. We present implementation results of a school-based intervention that has been reported to have a modest impact among children in grades 5-7. Methods. The School Nutrition Policy Initiative (SNPI) was a multi-component intervention, conducted as a cluster-randomized trial in an urban public school setting. Intervention elements included school self-assessment (School Health Index, SHI, each module scored on 100-point scale); nutrition education for staff (target ~10 hrs/teacher); nutrition education instruction to students (target ~50 hrs/student); changes to school nutrition policies; social marketing; and family and community involvement. Results. The SNPI involved five intervention and five control schools (grades K-8), with 89% minority students (53% African Americans, 19% Hispanics, 15% Asian Americans). SHI scores for family and community involvement increased by 6 points in the intervention and decreased by 9 points in the control schools, but changes in other SHI modules were similar in the two groups. About two thirds of the school staff received some nutrition education training (average = 5 hrs/teacher), while less than half of the school staff provided any nutrition education to students (average = 35 hrs/student), with more than half of it delivered in kindergarten and first grade. Conclusions. The process metrics suggest that implementation of complex interventions in urban public school settings may be uneven. Consequently, the effect of interventions may be modest overall and may differentially affect specific age groups.