Pathways
Principal
Investigators
Mary Story, PhD, University of Minnesota; Benjamin Caballero,
MD, Johns Hopkins University; Elaine J. Stone, PhD, MS, National
Heart, Lung, and Blood Institute; June Stevens, PhD, University
of North Carolina, Sally Davis, PhD, University of New Mexico;
Timothy Lohman, PhD, University of Arizona-Tucson; Larry Stephenson,
PhD, Gila River Indian Community-AZ
Funding
National Heart, Lung, and Blood Institute
Objective
A multi-site school-based study aimed at reducing the alarming
increase in the prevalence of obesity in American Indian children.
Methods
The components of the intervention consisted of a school food
service program; 3rd, 4th, and 5th grade classroom curricula,
a physical education curriculum, and family programs (family
take home information and snack packs, and family night programs).
Results
Although there were no differences in average percent body fat
between intervention and control groups, the percent of calories
from fat in school lunch was reduced significantly in intervention
schools. Total energy intake by 24-hour recall was also significantly
reduced in intervention schools, although lunch energy intake
was no different when assessed by direct observation. Although
children in intervention schools reported significantly more
physical activity, motion sensor data showed similar activity
level in both groups. Several components of knowledge, attitudes,
and behaviors were also positively and significantly changed
by the intervention. No adverse effects related to the intervention
were identified.
Conclusion
These results document the feasibility of implementing a multi-component
program for obesity prevention in elementary schools serving
American Indian communities. The program, delivered by teachers
and other school staff, produced a significant reduction in
intake of total and saturated fat calories, and significant
improvements in food- and health-related knowledge, attitudes,
and behaviors. The lack of effect on percent body fat suggests
that more intense or longer interventions will be needed to
modify the continuing trend toward higher adiposity in this
population.
Materials
Pathways curricula and classroom materials, family component
materials, and School Food Service guidelines and materials
available for download at the following website: http://hsc.unm.edu/pathways/
Publications
Caballero B, Clay T, Davis S, Ethelbah B, Holy Rock B, Lohman
T, Norman J, Story M, Stone E, Stephenson L, Stevens J. Impact
of a school-based obesity prevention program on body composition,
physical activity, dietary intake, and behavior in American
Indian children: the Pathways randomized trial. (Submitted.)
